Circulating albumin-to-fibrinogen ratio may be a risk indicator for venous thromboembolism: findings from a population-based prospective cohort study


Submitted: 5 May 2022
Accepted: 1 June 2022
Published: 14 July 2022
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Authors

  • Setor K. Kunutsor National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, UK; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland.
  • Sudhir Kurl Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
  • Ari Voutilainen Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
  • Jari Laukkanen Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland.

Circulating albumin and fibrinogen levels, commonly considered as inflammatory markers, have been shown to be associated with venous thromboembolism (VTE) risk. Circulating albumin-to-fibrinogen ratio (AFR) has been proposed as a novel inflammatory biomarker, but its association with VTE risk has not been investigated. We aimed to assess the prospective association of AFR with VTE risk. Circulating albumin and fibrinogen levels were measured at baseline in 2,284 men aged 42-61 years. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. During a median follow-up of 27.0 years, 156 VTE cases were recorded. In analysis adjusted for established risk factors, the HR (95% CI) for VTE comparing extreme tertiles of AFR was 1.53 (1.02-2.32), which remained similar on further adjustment for prevalent cancer, 1.52 (1.01-2.30). The associations of circulating albumin or fibrinogen with VTE risk were modest. Circulating AFR may be a stronger risk indicator for VTE compared with albumin or fibrinogen alone.


Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 2008;28:370-2. DOI: https://doi.org/10.1161/ATVBAHA.108.162545

Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol 2015;12:464-74. DOI: https://doi.org/10.1038/nrcardio.2015.83

Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol 2007;44:62-9. DOI: https://doi.org/10.1053/j.seminhematol.2007.02.004

Rosendaal FR. Risk factors for venous thrombotic disease. Thromb Haemost 1999;82:610-9. DOI: https://doi.org/10.1055/s-0037-1615887

Fox EA, Kahn SR. The relationship between inflammation and venous thrombosis. A systematic review of clinical studies. Thromb Haemost 2005;94:362-5. DOI: https://doi.org/10.1160/TH05-04-0266

Kunutsor SK, Sameul S, Blom AW, et al. Serum C-reactive protein increases the risk of venous thromboembolism: A prospective study and meta-analysis of published prospective evidence Eur J Epidemiol 2017 32:657-67. DOI: https://doi.org/10.1007/s10654-017-0277-4

Kunutsor SK, Seidu S, Katechia DT, Laukkanen JA. Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein. Ann Med 2018:1-9. DOI: https://doi.org/10.1080/07853890.2018.1441537

Klovaite J, Nordestgaard BG, Tybjaerg-Hansen A, Benn M. Elevated fibrinogen levels are associated with risk of pulmonary embolism, but not with deep venous thrombosis. Am J Respir Crit Care Med 2013;187:286-93. DOI: https://doi.org/10.1164/rccm.201207-1232OC

Chi G, Gibson CM, Liu Y, et al. Inverse relationship of serum albumin to the risk of venous thromboembolism among acutely ill hospitalized patients: Analysis from the APEX trial. Am J Hematol 2019;94:21-8. DOI: https://doi.org/10.1002/ajh.25296

Lin C, Chen Y, Chen B, et al. D-Dimer Combined with Fibrinogen Predicts the Risk of Venous Thrombosis in Fracture Patients. Emerg Med Int 2020;2020:1930405. DOI: https://doi.org/10.1155/2020/1930405

Wang J, Xi H, Zhang K, et al. Circulating C-Reactive Protein to Prealbumin Ratio and Prealbumin to Fibrinogen Ratio are Two Promising Inflammatory Markers Associated with Disease Activity in Rheumatoid Arthritis. Clin Lab 2020;66. DOI: https://doi.org/10.7754/Clin.Lab.2019.190833

Simera I, Moher D, Hoey J, et al. A catalogue of reporting guidelines for health research. Eur J Clin Invest 2010;40:35-53. DOI: https://doi.org/10.1111/j.1365-2362.2009.02234.x

Salonen JT. Is there a continuing need for longitudinal epidemiologic research? The Kuopio Ischaemic Heart Disease Risk Factor Study. Ann Clin Res 1988;20:46-50.

Kunutsor SK, Khan H, Laukkanen JA. Serum albumin concentration and incident type 2 diabetes risk: new findings from a population-based cohort study. Diabetologia 2015;58:961-7. DOI: https://doi.org/10.1007/s00125-015-3520-0

Liu Z, Mi J. Serum Albumin and Circulating Metabolites and Risk of Venous Thromboembolism: A Two-Sample Mendelian Randomization Study. Front Nutr 2021;8:712600. DOI: https://doi.org/10.3389/fnut.2021.712600

Folsom AR, Lutsey PL, Heckbert SR, Cushman M. Serum albumin and risk of venous thromboembolism. Thromb Haemost 2010;104:100-4. DOI: https://doi.org/10.1160/TH09-12-0856

Shaper AG, Wannamethee SG, Whincup PH. Serum albumin and risk of stroke, coronary heart disease, and mortality: the role of cigarette smoking. J Clin Epidemiol 2004;57:195-202. DOI: https://doi.org/10.1016/j.jclinepi.2003.07.001

Smith EB. Fibrinogen, fibrin and the arterial wall. Eur Heart J 1995;16A:11-4. DOI: https://doi.org/10.1093/eurheartj/16.suppl_A.11

Lip GY, Lowe GD. Fibrin D-dimer: a useful clinical marker of thrombogenesis? Clin Sci (Lond) 1995;89:205-14. DOI: https://doi.org/10.1042/cs0890205

Kunutsor, S. K., Kurl, S., Voutilainen, A. ., & Laukkanen, J. (2022). Circulating albumin-to-fibrinogen ratio may be a risk indicator for venous thromboembolism: findings from a population-based prospective cohort study. Bleeding, Thrombosis, and Vascular Biology, 1(2). https://doi.org/10.4081/btvb.2022.36

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