Effects of prognostic nutritional index and albumin to fibrinogen ratio on health-related quality of life in patients with venous thromboembolism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Ling ^1,2 , HUANG Jing ^1,2 , REN Li ^1,2 , MA Yukui ¹ ,  WU Zhoupeng ¹

1. Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Nursing, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WU Zhoupeng, Email: lzwzp19@163.com

Keywords：

venous thromboembolism; prognostic nutritional index; albumin-to-fibrinogen ratio; health-related quality of life

DOI：

10.7507/1007-9424.202605126

Video：

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Objective To investigate the relevance of prognostic nutritional index (PNI) and albumin to fibrinogen ratio (AFR) to health-related quality of life in patients with venous thromboembolism (VTE) after 1 year discharge. Methods The clinical data from the 292 patients with VTE receiving 3 or 6 months of anticoagulation therapy at the West China Hospital of Sichuan University, from January 2020 to October 2024, were retrospective analyzed. Generalized linear model (Gamma distribution with log link) was used to assess the relationship of PNI, AFR, and their interaction termwith the Global Index Score (GIS) at 1 year discharge. Results The correlation analysis showed that AFR (r_s=0.325, P<0.001) and PNI (r_s=0.322, P<0.001) were positively correlated with GIS after 1 year discharge. In adjusted generalized linear model controlling for age, education, and comorbidities, pulmonary embolism [without pulmonary embolism vs. pulmonary embolism: MR=0.942, 95%CI (0.897, 0.989), P=0.017], VTE recurrence [without VTE recurrence vs. VTE recurrence: MR=1.236, 95%CI (1.168, 1.308), P<0.001], AFR level [MR=1.038, 95%CI (1.018, 1.059), P<0.001] and PNI level [MR=1.014, 95%CI (1.009, 1.018), P<0.001] were associated with GIS after 1 year discharge, PNI and AFR had significant negative effect on GIS [MR=0.999, 95%CI (0.999, 1.000), P<0.001)]. Conclusions PNI and AFR are associated with health-related quality of life in VTE patients after 1 year discharge. A non-linear interaction between PNI and AFR suggesting that there is a complicated coordinate regulation between them.

Citation： LI Ling, HUANG Jing, REN Li, MA Yukui, WU Zhoupeng. Effects of prognostic nutritional index and albumin to fibrinogen ratio on health-related quality of life in patients with venous thromboembolism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(8): 1084-1090. doi: 10.7507/1007-9424.202605126 Copy

1.	Chopard R, Albertsen IE, Piazza G. Diagnosis and treatment of lower extremity venous thromboembolism: a review [J]. JAMA, 2020, 324(17): 1765-1776.
2.	H?jen AA, Lindegaard SF, Grove EL, et al. Development of a structured integrated post-pulmonary embolism care model: the Attend-PE model [J]. J Thromb Haemost, 2024, 22(11): 3137-3147.
3.	Münster AM, Rasmussen TB, Falstie-Jensen AM, et al. A changing landscape: temporal trends in incidence and characteristics of patients hospitalized with venous thromboembolism 2006-2015 [J]. Thromb Res, 2019, 176: 46-53.
4.	Yang Y, Liang L, Zhai Z, et al. Pulmonary embolism incidence and fatality trends in chinese hospitals from 1997 to 2008: a multicenter registration study [J/OL]. PLoS One, 2011, 6(11): e26861. doi: 10.1371/journal.pone.0026861.
5.	Bikdeli B, Wang Y, Jimenez D, et al. Pulmonary embolism hospitalization, readmission, and mortality rates in US older adults, 1999-2015 [J]. JAMA, 2019, 322(6): 574-576.
6.	Kobayashi S, Ogihara Y, Yamashita Y, et al. Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2 [J/OL]. Res Pract Thromb Haemost, 2025, 9(5): 102965. doi: 10.1016/j.rpth.2025.102965.
7.	Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life [J]. Ann Intern Med, 1993, 118(8): 622-629.
8.	Font C, Gomez-Mesa JE, López-Nú?ez JJ, et al. Measurement of adherence and health-related quality of life during anticoagulation therapy in cancer-associated venous thromboembolism (VTE): a multicenter quantitative study [J/OL]. Support Care Cancer, 2023, 31(10): 615. doi: 10.1007/s00520-023-08073-y.
9.	Valerio L, Barco S, Jankowski M, et al. Quality of life 3 and 12 months following acute pulmonary embolism: analysis from a prospective multicenter cohort study [J]. Chest, 2021, 159(6): 2428-2438.
10.	Kahn SR, Shbaklo H, Lamping DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis [J]. J Thromb Haemost, 2008, 6(7): 1105-1112.
11.	Wang H, Zhou Q, Wang Z, et al. Prognostic nutritional index as a potential biomarker for the risk of lower extremity deep venous thrombosis: a large retrospective study [J/OL]. Clin Appl Thromb Hemost, 2025, 31: 10760296251317520. doi: 10.1177/10760296251317520.
12.	Guclu H, Ozal SA, Pelitli Gurlu V, et al. Increased fibrinogen to albumin ratio in ischemic retinal vein occlusions [J]. Eur J Ophthalmol, 2017, 27(6): 735-739.
13.	Li S, Huang S, Wang W, et al. The prognostic nutritional index improves risk stratification for acute pulmonary embolism [J/OL]. iScience, 2026, 29(2): 114623. doi: 10.1016/j.isci.2025.114623.
14.	Hay?ro?lu M?, Keskin M, Keskin T, et al. A novel independent survival predictor in pulmonary embolism: prognostic nutritional index [J]. Clin Appl Thromb Hemost, 2018, 24(4): 633-639.
15.	王蔚文. 臨床疾病診斷與療效判定標準 [M]. 北京: 科學技術文獻出版社, 2010.
16.	中華醫學會腸外腸內營養學分會營養風險-不足-支持-結局-成本/效果多中心協作組. 營養風險篩查和全球 (營養) 領導人發起的營養不良診斷 (GLIM) 第二、三步流程 (共識 2020) [J]. 中華臨床營養雜志, 2020, 28(4): 193-200.
17.	Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [J]. Nihon Geka Gakkai Zasshi, 1984, 85(9): 1001-1005.
18.	Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ) [J]. Qual Life Res, 1996, 5(6): 539-554.
19.	Eichinger S, Minar E, Bialonczyk C, et al. D-dimer levels and risk of recurrent venous thromboembolism [J]. JAMA, 2003, 290(8): 1071-1074.
20.	Huang J, Liu XY, Wu ZP, et al. Quality of life status and influencing factors among patients with deep vein thrombosis [J]. Patient Prefer Adherence, 2022, 16: 949-956.
21.	Roche M, Rondeau P, Singh NR, et al. The antioxidant properties of serum albumin [J]. FEBS Lett, 2008, 582(13): 1783-1787.
22.	Mazzaferro EM, Edwards T. Update on albumin therapy in critical illness [J]. Vet Clin North Am Small Anim Pract, 2020, 50(6): 1289-1305.
23.	Rael LT, Leonard J, Salottolo K, et al. Plasma oxidized albumin in acute ischemic stroke is associated with better outcomes [J/OL]. Front Neurol, 2019, 10: 709. doi: 10.3389/fneur.2019.00709.
24.	Joles JA, Willekes-Koolschijn N, Koomans HA. Hypoalbuminemia causes high blood viscosity by increasing red cell lysophosphatidylcholine [J]. Kidney Int, 1997, 52(3): 761-770.
25.	Luther N, Shahneh F, Br?hler M, et al. Innate effector-memory T-cell activation regulates post-thrombotic vein wall inflammation and thrombus resolution [J]. Circ Res, 2016, 119(12): 1286-1295.
26.	Kassab RB, Elhenawy AA, AbdulrahmanTheyab None, et al. Modulation of inflammatory, oxidative, and apoptotic stresses mediates the renoprotective effect of daidzein against glycerol-induced acute kidney injury in rats [J]. Environ Sci Pollut Res Int, 2023, 30(56): 119016-119033.
27.	Jensen T, Kierulf P, Sandset PM, et al. Fibrinogen and fibrin induce synthesis of proinflammatory cytokines from isolated peripheral blood mononuclear cells [J]. Thromb Haemost, 2007, 97(5): 822-829.
28.	Machlus KR, Cardenas JC, Church FC, et al. Causal relationship between hyperfibrinogenemia, thrombosis, and resistance to thrombolysis in mice [J]. Blood, 2011, 117(18): 4953-4963.
29.	Induruwa I, Moroi M, Bonna A, et al. Platelet collagen receptor glycoprotein Ⅵ-dimer recognizes fibrinogen and fibrin through their D-domains, contributing to platelet adhesion and activation during thrombus formation [J]. J Thromb Haemost, 2018, 16(2): 389-404.
30.	李玲, 黃靖, 許靜, 等. 白蛋白與纖維蛋白原比值和預后營養指數與靜脈血栓栓塞癥復發的關系[J]. 中國普外基礎與臨床雜志, 2025, 32(6): 775-778.
31.	Karahan O, Yavuz C, Kankilic N, et al. Simple blood tests as predictive markers of disease severity and clinical condition in patients with venous insufficiency [J]. Blood Coagul Fibrinolysis, 2016, 27(6): 684-690.
32.	Zhao Y, Yang J, Ji Y, et al. Usefulness of fibrinogen-to-albumin ratio to predict no-reflow and short-term prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention [J]. Heart Vessels, 2019, 34(10): 1600-1607.
33.	Steiner D, Nopp S, Hoberstorfer T, et al. Anxiety in patients with venous thromboembolism: quantification and risk factors in a prospective cohort study [J]. J Thromb Haemost, 2024, 22(12): 3490-3499.
34.	Carrillo-Balam G, Lee T, Rajanderan T, et al. “Incredibly Overwhelming”: a reflexive thematic analysis of the psychological impact of venous thromboembolism-a patient-oriented study[J/OL]. J Patient Exp, 2026, 13: 23743735261415656. doi: 10.1177/23743735261415656.
35.	Palmcrantz S, Holmqvist LW, Sommerfeld DK, et al. Differences between younger and older individuals in their use of care and rehabilitation but not in self-perceived global recovery 1year after stroke [J]. J Neurol Sci, 2012, 321(1-2): 29-34.
36.	Wang H, Klok FA, Rosendaal FR, et al. Health-related quality of life after first venous thromboembolism in individuals aged 70 years and older [J/OL]. Res Pract Thromb Haemost, 2023, 7(5): 102144. doi: 10.1016/j.rpth.2023.102144.

1. Chopard R, Albertsen IE, Piazza G. Diagnosis and treatment of lower extremity venous thromboembolism: a review [J]. JAMA, 2020, 324(17): 1765-1776.
2. H?jen AA, Lindegaard SF, Grove EL, et al. Development of a structured integrated post-pulmonary embolism care model: the Attend-PE model [J]. J Thromb Haemost, 2024, 22(11): 3137-3147.
3. Münster AM, Rasmussen TB, Falstie-Jensen AM, et al. A changing landscape: temporal trends in incidence and characteristics of patients hospitalized with venous thromboembolism 2006-2015 [J]. Thromb Res, 2019, 176: 46-53.
4. Yang Y, Liang L, Zhai Z, et al. Pulmonary embolism incidence and fatality trends in chinese hospitals from 1997 to 2008: a multicenter registration study [J/OL]. PLoS One, 2011, 6(11): e26861. doi: 10.1371/journal.pone.0026861.
5. Bikdeli B, Wang Y, Jimenez D, et al. Pulmonary embolism hospitalization, readmission, and mortality rates in US older adults, 1999-2015 [J]. JAMA, 2019, 322(6): 574-576.
6. Kobayashi S, Ogihara Y, Yamashita Y, et al. Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2 [J/OL]. Res Pract Thromb Haemost, 2025, 9(5): 102965. doi: 10.1016/j.rpth.2025.102965.
7. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life [J]. Ann Intern Med, 1993, 118(8): 622-629.
8. Font C, Gomez-Mesa JE, López-Nú?ez JJ, et al. Measurement of adherence and health-related quality of life during anticoagulation therapy in cancer-associated venous thromboembolism (VTE): a multicenter quantitative study [J/OL]. Support Care Cancer, 2023, 31(10): 615. doi: 10.1007/s00520-023-08073-y.
9. Valerio L, Barco S, Jankowski M, et al. Quality of life 3 and 12 months following acute pulmonary embolism: analysis from a prospective multicenter cohort study [J]. Chest, 2021, 159(6): 2428-2438.
10. Kahn SR, Shbaklo H, Lamping DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis [J]. J Thromb Haemost, 2008, 6(7): 1105-1112.
11. Wang H, Zhou Q, Wang Z, et al. Prognostic nutritional index as a potential biomarker for the risk of lower extremity deep venous thrombosis: a large retrospective study [J/OL]. Clin Appl Thromb Hemost, 2025, 31: 10760296251317520. doi: 10.1177/10760296251317520.
12. Guclu H, Ozal SA, Pelitli Gurlu V, et al. Increased fibrinogen to albumin ratio in ischemic retinal vein occlusions [J]. Eur J Ophthalmol, 2017, 27(6): 735-739.
13. Li S, Huang S, Wang W, et al. The prognostic nutritional index improves risk stratification for acute pulmonary embolism [J/OL]. iScience, 2026, 29(2): 114623. doi: 10.1016/j.isci.2025.114623.
14. Hay?ro?lu M?, Keskin M, Keskin T, et al. A novel independent survival predictor in pulmonary embolism: prognostic nutritional index [J]. Clin Appl Thromb Hemost, 2018, 24(4): 633-639.
15. 王蔚文. 臨床疾病診斷與療效判定標準 [M]. 北京: 科學技術文獻出版社, 2010.
16. 中華醫學會腸外腸內營養學分會營養風險-不足-支持-結局-成本/效果多中心協作組. 營養風險篩查和全球 (營養) 領導人發起的營養不良診斷 (GLIM) 第二、三步流程 (共識 2020) [J]. 中華臨床營養雜志, 2020, 28(4): 193-200.
17. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [J]. Nihon Geka Gakkai Zasshi, 1984, 85(9): 1001-1005.
18. Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ) [J]. Qual Life Res, 1996, 5(6): 539-554.
19. Eichinger S, Minar E, Bialonczyk C, et al. D-dimer levels and risk of recurrent venous thromboembolism [J]. JAMA, 2003, 290(8): 1071-1074.
20. Huang J, Liu XY, Wu ZP, et al. Quality of life status and influencing factors among patients with deep vein thrombosis [J]. Patient Prefer Adherence, 2022, 16: 949-956.
21. Roche M, Rondeau P, Singh NR, et al. The antioxidant properties of serum albumin [J]. FEBS Lett, 2008, 582(13): 1783-1787.
22. Mazzaferro EM, Edwards T. Update on albumin therapy in critical illness [J]. Vet Clin North Am Small Anim Pract, 2020, 50(6): 1289-1305.
23. Rael LT, Leonard J, Salottolo K, et al. Plasma oxidized albumin in acute ischemic stroke is associated with better outcomes [J/OL]. Front Neurol, 2019, 10: 709. doi: 10.3389/fneur.2019.00709.
24. Joles JA, Willekes-Koolschijn N, Koomans HA. Hypoalbuminemia causes high blood viscosity by increasing red cell lysophosphatidylcholine [J]. Kidney Int, 1997, 52(3): 761-770.
25. Luther N, Shahneh F, Br?hler M, et al. Innate effector-memory T-cell activation regulates post-thrombotic vein wall inflammation and thrombus resolution [J]. Circ Res, 2016, 119(12): 1286-1295.
26. Kassab RB, Elhenawy AA, AbdulrahmanTheyab None, et al. Modulation of inflammatory, oxidative, and apoptotic stresses mediates the renoprotective effect of daidzein against glycerol-induced acute kidney injury in rats [J]. Environ Sci Pollut Res Int, 2023, 30(56): 119016-119033.
27. Jensen T, Kierulf P, Sandset PM, et al. Fibrinogen and fibrin induce synthesis of proinflammatory cytokines from isolated peripheral blood mononuclear cells [J]. Thromb Haemost, 2007, 97(5): 822-829.
28. Machlus KR, Cardenas JC, Church FC, et al. Causal relationship between hyperfibrinogenemia, thrombosis, and resistance to thrombolysis in mice [J]. Blood, 2011, 117(18): 4953-4963.
29. Induruwa I, Moroi M, Bonna A, et al. Platelet collagen receptor glycoprotein Ⅵ-dimer recognizes fibrinogen and fibrin through their D-domains, contributing to platelet adhesion and activation during thrombus formation [J]. J Thromb Haemost, 2018, 16(2): 389-404.
30. 李玲, 黃靖, 許靜, 等. 白蛋白與纖維蛋白原比值和預后營養指數與靜脈血栓栓塞癥復發的關系[J]. 中國普外基礎與臨床雜志, 2025, 32(6): 775-778.
31. Karahan O, Yavuz C, Kankilic N, et al. Simple blood tests as predictive markers of disease severity and clinical condition in patients with venous insufficiency [J]. Blood Coagul Fibrinolysis, 2016, 27(6): 684-690.
32. Zhao Y, Yang J, Ji Y, et al. Usefulness of fibrinogen-to-albumin ratio to predict no-reflow and short-term prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention [J]. Heart Vessels, 2019, 34(10): 1600-1607.
33. Steiner D, Nopp S, Hoberstorfer T, et al. Anxiety in patients with venous thromboembolism: quantification and risk factors in a prospective cohort study [J]. J Thromb Haemost, 2024, 22(12): 3490-3499.
34. Carrillo-Balam G, Lee T, Rajanderan T, et al. “Incredibly Overwhelming”: a reflexive thematic analysis of the psychological impact of venous thromboembolism-a patient-oriented study[J/OL]. J Patient Exp, 2026, 13: 23743735261415656. doi: 10.1177/23743735261415656.
35. Palmcrantz S, Holmqvist LW, Sommerfeld DK, et al. Differences between younger and older individuals in their use of care and rehabilitation but not in self-perceived global recovery 1year after stroke [J]. J Neurol Sci, 2012, 321(1-2): 29-34.
36. Wang H, Klok FA, Rosendaal FR, et al. Health-related quality of life after first venous thromboembolism in individuals aged 70 years and older [J/OL]. Res Pract Thromb Haemost, 2023, 7(5): 102144. doi: 10.1016/j.rpth.2023.102144.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effects of prognostic nutritional index and albumin to fibrinogen ratio on health-related quality of life in patients with venous thromboembolism

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