Fibrinogen and the Prediction of Residual Obstruction Manifested after Pulmonary Embolism Treatment

Residual pulmonary vascular obstruction (RPVO) and chronic thromboembolic pulmonary hypertension (CTEPH) are both long-term complications of acute pulmonary embolism (PE), but it is unknown whether RPVO can be predicted by variants of fibrinogen associated with CTEPH. We use Akaike Information Criterion to select the best predictive models for RPVO in two prospectively followed cohorts of acute PE patients, using as candidate variables the extent of the initial obstruction, clinical characteristics and fibrinogen-related data. We measured the selected models’ goodness of fit by analysis of deviance and compared models by χ 2 test. RPVO occurred in 29/102 (28.4%) subjects in the first cohort and 46/182 (25.3%) subjects in the second. The best-fit predictive model derived in the first cohort (p=0.0002) and validated in the second cohort (p=0.0005) implicated fibrinogen Bβ-chain monosialylation in the development of RPVO. When the derivation procedure excluded clinical characteristics, fibrinogen Bβ-chain monosialylation remained a predictor of RPVO in the best-fit predictive model (p=0.00003). Excluding fibrinogen characteristics worsened the predictive model (p=0.03). Fibrinogen Bβ-chain monosialylation, a common structural attribute of fibrin, helped predict RPVO after acute PE. Fibrin structure may contribute to the risk of developing RPVO.