title: Hypofibrinogenemia as a clue in the presumptive diagnosis of acute promyelocytic leukemia.
abstract: Acute promyelocytic leukemia (APL) is a medical emergency. In order to evaluate the usefulness of initial coagulation parameters in the predictive value of APL diagnosis, 1304 consecutive newly diagnosed acute leukemia patients, including APL (n=211), non-APL acute myeloid leukemia (n=781) and acute lymphoblastic leukemia (n=312) were retrospectively evaluated between January 2011 and May 2015. The area under curve (AUC) of fibrinogen was the largest among the coagulation markers based on receiver operating characteristic (ROC) analysis. The optimum cutoff value of fibrinogen was 1.87g/L (AUC=0.912, sensitivity 80.1% and specificity 88.8%). The optimum cutoff value of D-dimer was 2191μg/L (AUC=0.786, sensitivity 81.1% and specificity 67.8%). The AUC difference between the fibrinogen and D-dimer was significant (P<0.001). Other coagulation markers showed less predictive power. Importantly, in the analysis of high white blood cell count (over 10×109/L) subgroup, a low fibrinogen level could efficiently discriminate APL patients from controls (AUC=0.983, sensitivity 96.4% and specificity 94.4%) with a criterion value ≤1.71g/L. Thus, our results suggest that a low fibrinogen level could be a key marker in early prediction of APL diagnosis.
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
authors.forename: Yinjun
authors.initials: Y
authors.lastname: Lou
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
authors.forename: Shanshan
authors.initials: S
authors.lastname: Suo
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Tong
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
authors.forename: Wenbin
authors.initials: W
authors.lastname: Qian
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Mai
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Meng
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
authors.forename: Wenjuan
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
authors.forename: Juyin
authors.initials: J
authors.lastname: Wei
authors.affiliation: Department of Hematology, Institute of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, China. Electronic address: zjuhematology@163.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D000347:Afibrinogenemia; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D001777:Blood Coagulation; D016022:Case-Control Studies; D042241:Early Diagnosis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen
keywords: Acute promyelocytic leukemia; Early death; Fibrinogen; Presumptive diagnosis