The coagulation status in women of endometriosis with stage IV

Abstract

Background: Endometriosis is considered as a systemic disease with the presence of proinflammatory cytokines in the circulation, which drives hypercoagulable state of endometriosis. Currently, endometriosis is classified into four stages: I (minimal), II (mild), III (moderate) and IV (severe). The aim of this study is to investigate the correlations between inflammatory markers and coagulation factors in patients diagnosed of endometriosis with stage IV.

Methods: This retrospective case-control study included 171 endometriosis patients with stage IV and 184 controls. Continuous data were expressed by mean ± standard deviation. Mann-Whitney U and χ2 tests were used to compare the medians and frequencies among the groups. Spearman analysis was conducted to determine the correlation among the measured parameters. The diagnostic values of the parameters differentiating endometriomas were tested by receiver operating characteristic (ROC) curve.

Results: The time of activated partial thromboplastin time (APTT) was decreased and the concentration of fibrinogen (FIB) and neutrophil-to-lymphocyte ratio (NLR) were increased in women of endometriosis with stage IV. The APTT were negatively correlated with NLR while the concentrations of FIB were positively correlated with NLR. The ROC analysis showed that the Area under the curve (AUC) of FIB was 0.766 (95% confidence interval:0.717-0.814) with sensitivity and specificity reaching 86.5 and 60.9%, respectively. The AUC of CA125 and CA199 was 0.638 (95% confidence interval: 0.578-0.697), 0.71 (95% confidence interval: 0.656-0.763) with sensitivity and specificity reaching 40.9 and 91.8%, 80.7 and 56.5% respectively. The combination of these factors showed the highest AUC of 0.895 (0.862-0.927) with sensitivity of 88.9% and specificity of 77.7%.

Conclusion: In the present study, we found that inflammatory factors showed significant correlation with APTT or FIB in endometriosis with stage IV. Moreover, the coagulation factors combined with CA125 and CA199 were more reliable for identifying the endometriosis with stage IV.

Keywords: Endometriosis; Hypercoagulability; Inflammation; Stage IV.

Fig. 1

The coagulation factors and NLR in groups. a-d, Coagulation factors of APTT(a), TT(b), PT(c) and FIB(d) between controls and endometriosis with stage IV. e, NLR between controls and endometriosis with stage IV. APTT, activated partial thromboplastin time; TT, thrombin time; PT, prothrombin time; FIB, fibrinogen; NLR, neutrophil-to-lymphocyte ratio. ** P < 0.01, **** P < 0.0001

Fig. 2

Correlations of coagulation factors and NLR in women of endometriosis with stage IV. a-d, The correlations of NLR with APTT (a), TT (b), PT (c) and FIB (d) were tested using Spearmen analysis. APTT, activated partial thromboplastin time; TT, thrombin time; PT, prothrombin time; FIB, fibrinogen; NLR, neutrophil-to-lymphocyte ratio

Fig. 3

Receiver operating characteristic curves of CA125, CA199, coagulation factors and the combined marker for the diagnosis of endometriomas with stage IV. a, The ROC analysis of CA125, CA199 and coagulation factors for the diagnosis of endometriomas with stage IV. b, The ROC analysis of combined marker for the diagnosis of endometriomas with stage IV. ROC, receiver operating characteristic; APTT, activated partial thromboplastin time; TT, thrombin time; PT, prothrombin time; FIB, fibrinogen; NLR, neutrophil-to-lymphocyte ratio