Plasma Fibrinogen as a Novel Noninvasive Index for Predicting and Quantifying Adhesions in Abdominal Emergency Surgery
Authors: Song Si-kai , Ji Jia-wei , Ma An-she , Zhuang Yun-feng , Zhang Wang , Zhu Jiang 
Published: November 2024

Abstract

Objective: Abdominal adhesions represent the most prevalent complication following abdominal surgery; however, there is a notable absence of effective laboratory examination that can be integrated with adhesion scoring systems to predict and quantify abdominal adhesions. This study aims to elucidate the association between plasma fibrinogen (Fg) and abdominal adhesions, while concurrently assessing the feasibility of integrating Fg with a simplified Peritoneal adhesion index (PAI) score for predicting and quantifying these adhesions. Furthermore, it seeks to establish a predictive equation for peritoneal adhesions.
Methods: This study retrospectively analyzed the clinical data of 231 patients diagnosed with acute appendicitis who underwent surgical treatment at The Third People's Hospital of Xinjiang Uygur Autonomous Region between July 2022 and August 2024. We assembled a comprehensive dataset encompassing basic demographic information and laboratory findings. Among these, the preoperative variables such as course of disease, Fg, D-dimer (D-D), white blood cell count (WBC), neutrophil count (NEU#), monocyte count (MONO#), eosinophil count (EOS#), basophil count (BASO#), and lymphocyte count (LYM#) were identified as independent variables. In the logistic regression analysis, the dependent variable was defined as the status of abdominal adhesion; in contrast, simplified PAI score was utilized as the dependent variable in the multiple linear regression equation.
Results: The results of the logistic regression analysis demonstrate that plasma Fg as an independent predictor of abdominal adhesion status, while other parameters, including NEU#, MONO#, and EOS#, exhibit no significant correlation. The area under the receiver operating characteristic curve (AUC) for diagnosing abdominal adhesion status using Fg was found to be 0.856. The optimal cut-off value was identified as 3.205 g/L, with sensitivity and specificity values of 72.3% and 88.4%, respectively. In accordance with the findings from multiple linear regression equation, both the course (β=0.269, p=0.001) and Fg (β=0.627, p<0.001) exhibited a significant association with the simplified PAI score. We formulated a predictive equation for abdominal adhesion: Y(simplified PAI score)=1.928 + 0.269 * course (days) + 0.672 * Fg (g/L), resulting in an R-squared value of 0.487. In predicting outcomes for recent emergency surgery patients, the predictive equation yielded an accuracy rate of merely 9.09% for the simplified PAI score among non-adhesion patients, whereas it attained a significant accuracy rate of 75% in those with adhesions. Nevertheless, when considering a Fg below 3.205 g/L as indicative of no adhesions, and integrating this criterion into the predictive equation, the overall predictive accuracy for the simplified PAI score increased to an impressive 93.33%.
Conclusion: Fg exhibits a significant correlation with abdominal adhesion and functions as a reliable predictor of the abdominal adhesion status in patients undergoing acute abdominal surgery prior to intervention. The simplified PAI score is correlated with Fg and course. However, when utilized in isolation, the predictive equation demonstrates suboptimal performance, particularly exhibiting reduced accuracy in patients without adhesions. To improve predictive accuracy, it is advisable to combine the criterion of fibrinogen levels below 3.205 g/L as indicative of the absence of adhesions with the predictive equation for assessing abdominal adhesions.