γ′/total fibrinogen ratio is associated with short-term outcome in ischaemic stroke

Fibrinogen gamma (gamma) is a natural isoform of fibrinogen, and alters the rate of formation and the properties of clots. It could therefore affect outcome after ischaemic stroke. The prognostic significance of gamma fibrinogen levels is, however, still unclear. It was the objective of this study to assess levels of gamma in ischaemic stroke, and its association with short-term outcome. We included 200 ischaemic stroke patients and 1 56 control persons. Total fibrinogen and gamma levels were measured; outcome at discharge was assessed by means of the modified Rankin Scale score (defined as unfavourable when > 2). We compared levels between patients and controls using multiple linear regression analysis, and logistic regression analysis was used to assess the relationship between levels and outcome. All analyses were adjusted for age and sex. Mean gamma levels were significantly higher in patients with ischaemic stroke than in controls (0.37 vs. 0.32 g/l, p < 0.001), and patients also had a higher gamma/total fibrinogen ratio (0.102 vs. 0.096, p=0.19). The gamma/total fibrinogen ratio is associated with unfavourable outcome in patients with ischaemic stroke (odds ratio per unit increase of gamma/total fibrinogen ratio 1.27, 95% confidence interval 1.09-1.47). Our study shows that patients with ischaemic stroke have increased levels of fibrinogen gamma and suggests a trend towards an increased gamma/total fibrinogen ratio in ischaemic stroke. Increased fibrinogen gamma relative to total fibrinogen levels are associated with unfavourable outcome in the early phase after stroke.