Fibrinogen-Albumin Ratio: A Potential New Marker for Gestational Diabetes Severity?

Abstract

Objectives: Approximately 15% of all pregnancies result in gestational diabetes mellitus (GDM). GDM is a common metabolic disease that is associated with significant changes in inflammatory markers and insulin sensitivity. Higher fibrinogen and lower albumin levels are observed during pregnancy. In addition, since GDM is also an inflammatory process, the fibrinogen-albumin ratio (FAR) may increase more than that in normal pregnancies, suggesting a potential role as an indicator of disease severity. The article aims to investigate the relationship between the severity of gestational diabetes (GDM) and the FAR. Materials and Methods: A prospective observational study was conducted at the Giresun Maternity and Children Training and Research Hospital. This study included 87 pregnant women, 41 women with GDM, and 46 women in the control group. Demographic, clinical, and biochemical parameters were collected, and FAR was computed. Statistical analyses were conducted to evaluate the diagnostic efficacy of FAR and compare the groups. Results: Compared to the control group, the GDM group had significantly higher fibrinogen levels (440±73.8 mg/dL vs. 403±57.9 mg/dL, p=0.012), lower albumin levels (36.61 vs. 38.80 g/L, p<0.001), and a higher FAR (12.28 vs. 10.07, p<0.001). A weak positive correlation was found between estimated fetal weight and FAR (p=0.04, r=0.22). ROC analysis demonstrated that FAR had an area under the curve of 0.810, a sensitivity of 78%, and a specificity of 71.7%, indicating acceptable diagnostic accuracy for GDM. Conclusion: In this study, pregnant women with GDM showed a significant increase in FAR, and this elevation correlated with fetal growth. The results of the study support the potential of FAR as a new biomarker in the management of GDM. However, further research is needed for these findings to translate into clinical applications.

Keywords

• Gestational diabetes mellitus (GDM)
• fibrinogen-to-albumin ratio (FAR)
• inflammatory markers
• insulin resistance

Fibrinojen-Albümin Oranı: Gestasyonel Diyabet Şiddeti için Potansiyel Yeni Bir Belirteç Olabilir mi?

Abstract

Amaç: Tüm gebeliklerin yaklaşık %15’i gestasyonel diabetes mellitus (GDM) ile sonuçlanabilmektedir. GDM enflamatuvar belirteçlerde ve insülin duyarlılığında önemli değişikliklerle ilişkili, yaygın bir metabolik hastalıktır. Gebelikte daha yüksek fibrinojen ve daha düşük albümin seviyeleri görülmektedir. Buna ek olarak GDM de enflamatuvar bir süreç olduğundan fibrinojen-albümin oranının (FAR) normal gebelere oranla daha fazla artabileceği, hastalığın şiddetinin göstergesi olarak potansiyel bir rol oynayabileceğini düşündürmektedir. Bu çalışmanın amacı, hamile kadınlarda GDM şiddeti ile FAR arasındaki bağlantıyı araştırmaktır. Gereç ve Yöntem: Giresun Kadın Doğum ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi’nde prospektif gözlemsel bir çalışma yürütüldü. Çalışmaya GDM (n=41) ve kontrol (n=46) gruplarına ayrılan 87 gebe kadın dahil edildi. Demografik, klinik ve biyokimyasal parametrelere ilişkin veriler toplandı ve FAR hesaplandı. Grupları karşılaştırmak ve FAR’ninn tanısal performansını değerlendirmek için istatistiksel analizler yapıldı

Keywords

• Gestasyonel diabetes mellitus (GDM)
• fibrinojen-albümin oranı (FAR)
• enflamatuvar belirteçler
• insülin direnci
• gebelik komplikasyonları

References

1. 1. Choudhury AA, Rajeswari VD. Gestational diabetes mellitus-A metabolic and reproductive disorder. Biomed Pharmacother. 2021;143:112183.
2. 2. Quintanilla Rodriguez BS, Vadakekut ES, Mahdy H. Gestational Diabetes. 2024. In: StatPearls [Internet].
3. 3. Siddiqui S, Waghdhare S, Jha S, et al. Role of immunological markers in gestational diabetes mellitus-a brief review. Diabetes Metab Syndr. 2019;13:2983-2985.
4. 4. Lorenzo PI, Martín-Montalvo A, Cobo Vuilleumier N, et al. Molecular Modelling of Islet β-Cell Adaptation to Inflammation in Pregnancy and Gestational Diabetes Mellitus. Int J Mol Sci. 2019;20:6171.
5. 5. Ruan Y, Yuan C, Liu Y, et al. High fibrinogen-to-albumin ratio is associated with hemorrhagic transformation in acute ischemic stroke patients. Brain Behav. 2021;11:e01855.
6. 6. Abu Samra N, Jelinek HF, Alsafar H, et al. Genomics and Epigenomics of Gestational Diabetes Mellitus: Understanding the Molecular Pathways of the Disease Pathogenesis. Int J Mol Sci. 2022;23:3514.
7. 7. Gao K, Zhang Y, Sun S, et al. Novel inflammatory markers in the blood of patients with knee synovitis. J Int Med Res. 2021;49:3000605211029557.
8. 8. Yuan D, Jiang P, Zhu P, et al. Prognostic value of fibrinogen in patients with coronary artery disease and prediabetes or diabetes following percutaneous coronary intervention: 5-year findings from a large cohort study. Cardiovasc Diabetol. 2021;20:143.

9. 9. You X, Zhou Q, Song J, et al. Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy. BMC Cancer. 2019;19:931.
10. 10. Xiao L, Jia Y, Wang X, et al. The impact of preoperative fibrinogen-albumin ratio on mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clin Chim Acta. 2019;493:8-13.
11. 11. Albayrak T, Muhtaroğlu A. The Relationship Between APACHE II Score and Immunological Parameters in Intensive Care Patients. Van Med J. 2023;30:367-373.
12. 12. Albayrak T, Yüksel B. Can the Fibrinogen-Albumin Ratio be a Predictor of Mortality in Dialysis Patients? J Ankara Univ Fac Med. 2024;77:101-106.
13. 13. Cui C, Yang S, Zhang J, et al. Trimester-specific coagulation and anticoagulation reference intervals for healthy pregnancy. Thromb Res. 2017;156:82-86.
14. 14. Gómez-Cantarino S, Agulló-Ortuño MT, de Dios-Aguado M, et al. Prevalence of Hypoproteinemia and Hypoalbuminemia in Pregnant Women from Three Different Socioeconomic Populations. Int J Environ Res Public Health. 2020;17:6275.
15. 15. Saravanan P, Deepa M, Ahmed Z, et al. Early pregnancy HbA1c as the first screening test for gestational diabetes: results from three prospective cohorts. Lancet Diabetes Endocrinol. 2024;12:535-544.
16. 16. Kansu-Celik H, Ozgu-Erdinc AS, Kisa B, et al. Prediction of gestational diabetes mellitus in the first trimester: comparison of maternal fetuin-A, N-terminal proatrial natriuretic peptide, high-sensitivity C-reactive protein, and fasting glucose levels. Arch Endocrinol Metab. 2019;63:121-127.
17. 17. Ureyen Ozdemir E, Buyuk GN, Erol Koc EM, et al. Gestational Diabetes and C-Reactive Protein/Albumin Ratio in Pregnancy: A Prospective Study. Yonsei Med J. 2024;65:413-417.
18. 18. Yilmaz H, Celik HT, Namuslu M, et al. Benefits of the neutrophil-tolymphocyte ratio for the prediction of gestational diabetes mellitus in pregnant women. Exp Clin Endocrinol Diabetes. 2014;122:39-43.
19. 19. Wei W, Zhang X. Expression of ADP and TNF-α in patients with gestational diabetes mellitus and its relationship with pregnancy outcomes. Exp Ther Med. 2020;20:2184-2190.
20. 20. Litvinov RI, Pieters M, de Lange-Loots Z, et al. Fibrinogen and Fibrin. Subcell Biochem. 2021;96:471-501.
21. 21. Esmon CT. Reprint of Crosstalk between inflammation and thrombosis. Maturitas. 2008;61:122-131.
22. 22. Levy JH, Goodnough LT. How I use fibrinogen replacement therapy in acquired bleeding. Blood. 2015;125:1387-1393.
23. 23. Zhu Y, Cai X, Liu Y, et al. Serum Albumin, but not Bilirubin, is Associated with Diabetic Chronic Vascular Complications in a Chinese Type 2 Diabetic Population. Sci Rep. 2019;9:12086.
24. 24. Wang K, Xu W, Zha B, et al. Fibrinogen to Albumin Ratio as an Independent Risk Factor for Type 2 Diabetic Kidney Disease. Diabetes Metab Syndr Obes. 2021;14:4557-4567.
25. 25. Thornton P, Douglas J. Coagulation in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2010;24:339-352.
26. 26. Katz D, Beilin Y. Disorders of coagulation in pregnancy. Br J Anaesth. 2015;115(Suppl 2):ii75-88.
27. 27. Hansen AT, Andreasen BH, Salvig JD, et al. Changes in fibrin D-dimer, fibrinogen, and protein S during pregnancy. Scandinavian journal of clinical and laboratory investigation. 2011;71:173-176.
28. 28. Ren H, Liu W, Niu A, et al. Fibrinogen to albumin ratio, a novel serum indicator for evaluating the severity of preeclampsia: A single-center retrospective study. Medicine (Baltimore). 2023; 102: e33419.
29. 29. Cimsir MT, Yildiz MS. Could fibrinogen to albumin ratio be a predictive marker for recurrent pregnancy loss. Int J Clin Pract. 2021;75:e14520.
30. 30. Usta CS, Atik TK, Ozcaglayan R, et al. Does the fibrinogen/albumin ratio predict the prognosis of pregnancies with abortus imminens? Saudi Med J. 2021;42:255-263.
31. 31. Şimşek F, Yevgi R. Assessment of fibrinogen albumin ratio in patients with pregnancy-related cerebral venous thrombosis. Acta Neurol Belg. 2023;123:2251-2258.