Journal of Vascular Medicine & Surgery

Abstract

Impact of Albumin and Fibrinogen on Early Brain Injury

Fang Liu*, Hao Ran Wang, Jie Ma, Yi Zhuo Guo, Ke Feng Liu, Bin Han, Ming Hai Wang, Fei Hui Zou, Jian Wang, Zhen Tian, He Qi Qu and Xian Long Huang

Cerebral Aneurysmal Subarachnoid Hemorrhage (aSAH) is a major cause of hemorrhagic stroke worldwide, with an annual incidence of 9 per 100,000 people, accounting for approximately 85% of Subarachnoid Hemorrhages (SAH). Once an aneurysm ruptures, there is a high risk of early patient mortality, emphasizing the need for prompt treatment. Surgical intervention can successfully treat a ruptured aneurysm and reduce the risk of rebleeding; however, 20% to 30% of patients may experience focal neurological or cognitive impairments. In patients with subarachnoid hemorrhage, early hypoalbuminemia is an independent predictor of hospital death. Albumin levels after subarachnoid hemorrhage have a time-dependent connection with death, with a stronger correlation with early mortality than with late mortality. Fibrinogen, spilling through the compromised blood-brain barrier, reaches the brain parenchyma. Procoagulants cause it to change into insoluble fibrin at the site of arterial rupture, where it deposits in the brain parenchyma. Through a number of mechanisms, fibrinogen both initiates and contributes to the inflammatory response of the post-bleeding neurological system. Fibrinogen increases the release of reactive oxygen species and the production of pro-inflammatory cytokines and chemokines after attaching to receptors on microglial/macrophage cells. Additionally, it can cause microglial cells to undergo M1-like metamorphosis, which exacerbates the inflammatory response of the nervous system and worsens disruption of the blood-brain barrier and brain injury. The Albumin/Fibrinogen Ratio (AFR), a novel inflammatory biomarker, has been shown to have considerable prognostic value in a range of illnesses, including cancer and myocardial infarction. In individuals with acute ischemic stroke, a lower AFR was found to be independently associated with a higher likelihood of hemorrhagic transformation. Moreover, AFR can indicate the degree of retinal vein blockage. The predictive value of AFR for patients with aSAH is currently unclear. The aim of this study was to examine the link between the admission HuntHess (HH) scale score and 6-month outcomes for patients with aSAH and AFR. One of the main effects of cerebral bleeding is brain edema, which is made worse by the increase in fibrinogen concentration, which, as was previously discussed, disrupts the blood-brain barrier in a number of ways. An overabundance of fibrinogen will impair patients' red blood cells' capacity to deform plastically, accelerate the lysis of red blood cells, and cause hyper coagulation in patients-A condition that increases the risk of secondary coagulation and the fibrinolysis system-as well as delayed cerebral edema.

Published Date: 2024-03-05; Received Date: 2024-01-28