Impact of Baseline Liver Function on the Dynamic Consumption of Fibrinogen During Double Filtration Plasmapheresis in Patients with Neuroimmune Diseases: A Retrospective Observational Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Objective : To investigate dynamic changes of fibrinogen (FIB) and immunoglobulin G (IgG) during double filtration plasmapheresis (DFPP) in neuroimmune diseases, and evaluate baseline liver function's impact on FIB consumption and severe hypofibrinogenemia risk. Methods : This retrospective study included 50 neuroimmune patients undergoing DFPP (June 2024-March 2026). Coagulation profiles were monitored per session. Multivariate linear regression identified factors influencing initial FIB reduction. In 43 patients with complete continuous data, severe hypofibrinogenemia (FIB < 1.0g/L) incidence during consecutive treatments was compared between high and low baseline alanine aminotransferase (ALT) groups, stratified by the median. Results : FIB and IgG showed a parallel, progressive decline during DFPP, with FIB reaching its nadir after the fourth session. Multivariate analysis identified baseline FIB and ALT as independent predictors of initial FIB reduction. Higher baseline ALT was associated with a smaller initial FIB reduction (beta = -0.010, 95%CI: -0.017 to -0.003, P = 0.009). However, during continuous therapy, severe hypofibrinogenemia incidence was 68.2% (15/22) in the high ALT group versus 42.9% (9/21) in the low ALT group (RR = 1.59, 95%CI: 0.90 to 2.81, P = 0.129). Safety analysis showed no major bleeding despite the absence of exogenous fibrinogen supplementation. Only 16.0% (8/50) experienced mild puncture site oozing, all effectively managed with local compression. Conclusion : DFPP causes significant but clinically well-tolerated fibrinogen consumption in patients with neuroimmune diseases. Higher baseline ALT may paradoxically increase the cumulative risk of severe hypofibrinogenemia during continuous therapy. Dynamic coagulation monitoring is essential to optimize safety and avoid unnecessary blood product transfusions.
Source: Research Square
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7203784477