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Fibrinogen and D-dimer protein levels in patients with preeclampsia: a systematic review and meta-analysis
Ermiyas Alemayehu1, Alemu Gedefie2, Fasil Getu3
1Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia. ermiyas0009@gmail.com.
Insights
D-dimer levels are significantly elevated in preeclampsia (PE) patients, suggesting its potential as a diagnostic biomarker. Fibrinogen levels did not show a significant difference, requiring further investigation.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Biomarker Discovery
Background:
- Preeclampsia (PE) is a major global health issue in pregnancy, linked to fetal growth restriction and maternal organ dysfunction.
- Early detection of PE using routine antenatal indicators is crucial for improved maternal and fetal outcomes.
- This systematic review and meta-analysis evaluated fibrinogen (FIB) and D-dimer (DD) as potential biomarkers for PE.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing fibrinogen and D-dimer levels in pregnant women with and without preeclampsia.
- To assess the diagnostic potential of FIB and DD as biomarkers for preeclampsia detection and monitoring.
- To provide evidence-based insights into the role of these hemostatic markers in PE pathophysiology.
Main Methods:
- Comprehensive literature search across major databases (PubMed, Scopus, Embase, Hinari).
- Random-effects meta-analysis using Stata 14.0 to calculate pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs).
- Assessment of heterogeneity using I² statistics and Cochrane Q test; investigation of heterogeneity through subgroup analyses, meta-regression, sensitivity analysis, Egger's regression test, and funnel plots.
Main Results:
- Included 31 articles with 5,846 participants (2,938 PE, 2,908 normotensive).
- Significantly elevated D-dimer (DD) levels observed in PE patients (SMD = 0.81, p < 0.001).
- No statistically significant difference in fibrinogen (FIB) levels between PE and normotensive groups (SMD = 0.26, p = 0.18).
Conclusions:
- D-dimer (DD) shows potential as a valuable biomarker for identifying and monitoring preeclampsia during pregnancy.
- Further research is needed to clarify the clinical implications and predictive value of DD levels in PE management.
- The non-significant findings for fibrinogen (FIB) warrant continued investigation into its role and underlying mechanisms in preeclampsia.
Introduction:
Preeclampsia (PE) is a significant obstetric and global health concern associated with fetal growth restriction, poor placental perfusion, and maternal organ dysfunction. Early detection through simple, routine antenatal indicators is essential. This systematic review and meta-analysis assessed fibrinogen (FIB) and D-dimer (DD) levels in PE patients compared to normotensive pregnant women.
Methods:
Relevant articles were systematically identified through comprehensive searches across multiple databases such as PubMed, Scopus, Embase, and Hinari. Utilizing Stata version 14.0, we employed a random-effects model to estimate the pooled standardized mean difference (SMD) along with their corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics and the Cochrane Q test, while subgroup analyses and meta-regression were conducted to investigate potential sources of heterogeneity. Additionally, sensitivity analysis was performed to assess the robustness of the findings. Furthermore, Egger's regression test and funnel plot were utilized to evaluate publication bias among the included studies.
Results:
In total, 31 articles involving 5,846 participants were included in this study. Among these, 2,938 were identified as patients with PE (664 severe PE, 619 mild PE, and 1,655 undefined PE), while 2,908 were normotensive pregnant mothers. The overall pooled standardized mean difference (SMD) for FIB and DD between PE and normotensive pregnant mothers were 0.26 (95% CI: -0.12-0.64, p = 0.18) and 0.81 (95% CI: 0.43-1.18, p < 0.001), respectively. These findings suggest a significant increase in DD levels among PE patients compared to normotensive pregnant mothers, while the elevation in FIB levels among PE patients did not reach statistical significance.
Conclusions:
These findings highlight the potential utility of DD as a biomarker for identifying and monitoring PE during pregnancy. However, further research is warranted to elucidate the clinical implications and predictive value of DD levels in the context of PE diagnosis and management. Additionally, the non-significant difference in FIB levels highlights the need for continued investigation into the underlying mechanisms and diagnostic relevance of FIB in PE.
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