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Blood Viscosity Should Not Be Overlooked When Evaluating the Fibrinogen to Albumin Ratio

Ertas et al reported that the fibrinogen to albumin ratio is an independent predictor of contrast-induced nephropathy (CIN) after carotid angiography. This ratio has emerged as a marker of coronary artery disease severity and cerebrovascular events by integrating 2 thrombotic, inflammatory, and hemorheological parameters, fibrinogen and albumin. The authors discussed the inflammatory and thrombotic properties of these 2 plasma proteins; we would like to also consider their hemorheological properties. Both fibrinogen and albumin are major components of whole blood viscosity, a risk marker of cardiovascular disease. Also, increased blood viscosity is an indicator of hemoconcentration leading to impaired renal function. Volume status is of critical importance in evaluating the risk of CIN. An elevated fibrinogen to albumin ratio may be a marker of hemoconcentration. Blood viscosity or plasma volume status can be estimated using simple equations. The evaluation of the fibrinogen to albumin ratio together with blood viscosity might improve the interpretation of the Ertas et al study and show whether this ratio has additional benefits over evaluating blood viscosity. The European Society of Cardiology guidelines recommend to assess the total contrast to glomerular filtration rate (GFR) ratio to evaluate the risk of CIN. We suggest that the evaluation of not only contrast volume but also total contrast to GFR ratio may improve the interpretation of the Ertas et al study. Heart failure patients are a high-risk population for CIN, and these patients are prone to a decrease in albumin level that may affect the results of this study. Therefore, patients with heart failure should be evaluated separately. We congratulate Ertas et al for evaluating a novel predictor of CIN. Contrast-induced nephropathy is an important, avoidable, but unfortunately underestimated, complication of interventions involving the use of contrast media. Any novel risk factor identifying patients at risk of developing CIN should make it possible to improve individual prevention treatment.