The following is the summary of “Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injury” published in the November 2022 issue of Renal failure by  Zhang, et al.

The inflammatory cascade, in which coagulation factors take part, is thought to be pivotal in the genesis of acute kidney injury (AKI). Therefore, it’s possible that there are elements connected to AKI. Low fibrinogen levels and antithrombin III (ATIII) activity have both been linked to an increased risk of death in sepsis patients. In addition, they have been linked to an increased risk of AKI. The prognosis of AKI has not been studied in relation to coagulation parameters, particularly fibrinogen, and ATIII. Information was retrieved from the Multiparameter Intelligent Monitoring in Intensive Care Database IV (MIMIC-IV) release 1.0. 

Researchers utilized a Cox proportional hazards regression model to examine the association between coagulation parameters and in-hospital mortality in seriously unwell patients with AKI. The association’s strength was tested by performing a subgroup analysis. By fitting a restricted cubic spline (RCS) curve, investigators could analyze the nonlinear associations between fibrinogen and ATIII and hospital mortality. The cumulative incidence of death was estimated by fibrinogen or ATIII levels using the Kaplan-Meier technique. Finally, the diagnostic accuracy of fibrinogen and ATIII was compared by plotting their receiver-operating characteristic (ROC) curves and calculating their area under the curves.

The Fibrinogen cohort study enrolled 5,914 individuals who met eligibility criteria, and the ATIII cohort study enrolled 115 patients who met the criteria. Low fibrinogen levels at baseline (<150 mg/dL) or low ATIII activity (<80%) were linked with significantly increased in-hospital mortality (hazard ratio [95% CIs]: fibrinogen 2.01 [1.79, 2.27], ATIII 3.73 [1.11, 12.54]). Multivariate analysis did not change the significant HR [95% CIs] of low fibrinogen, which was 1.29 (1.13, 1.48). Nearly linear correlation was seen in the RCS curve. Furthermore, subgroup analysis confirmed the consistency of the link between fibrinogen and hospital mortality. The predictive potential of fibrinogen and ATIII was shown by Kaplan-Meier survival curve and ROC. Patients in critical care who have AKI with a fibrinogen level that is too low have a significantly higher risk of dying while hospitalized. There is mounting evidence that suggests low ATIII activity contributes to an increased risk of hospital mortality.