Relationship Between Fibrinogen-to-Albumin Ratio and Pre-Eclampsia: A Retrospective Cohort Study

Preeclampsia is a leading cause of maternal and fetal morbidity and mortality, but cost-effective, accessible biomarkers remain limited. The fibrinogen-to-albumin ratio (FAR) is a promising inflammatory marker but has not been thoroughly evaluated in diverse populations for its association with preeclampsia.

We conducted a retrospective cohort analysis of 3,249 patients who delivered at a large academic center in New York City between March 2018 and February 2024. Patients were categorized as control (N = 2,216), preeclampsia without severe features (PE; N = 716), and preeclampsia with severe features (sPE; N = 317). Demographic, clinical, and laboratory characteristics were analyzed. Univariate and multivariate analysis with stepwise AIC selection assessed associations between FAR and preeclampsia. Discriminatory performance was evaluated using area under the curve.

FAR was significantly higher in PE groups compared to controls (P < 0.001). Univariate analysis showed significant associations between FAR and any PE (PE + sPE) (OR 25.2, 95 % CI: 6.63-95.82, P < 0.001) and sPE (OR 8.69, 95 % CI: 1.20-62.66, P = 0.032). In multivariate analysis, FAR was independently associated with PE (OR 6.16, 95 % CI: 1.49-25.56, P = 0.012), but not sPE (OR 2.42, 95 % CI: 0.29-18.89, P = 0.924). FAR alone had modest discriminatory power, which improved when combined with other clinical variables.

FAR is independently associated with preeclampsia and may assist clinicians in risk stratification and perioperative planning at labor admission. Prospective, multicenter studies are needed for further validation.