Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2021; 9(35): 10805-10815
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10805
Blood tests for prediction of deep endometriosis: A case-control study
Zheng-Yun Chen, Li-Feng Zhang, Yong-Qing Zhang, Yong Zhou, Xiao-Yong Li, Xiu-Feng Huang
Zheng-Yun Chen, Li-Feng Zhang, Yong-Qing Zhang, Yong Zhou, Xiao-Yong Li, Xiu-Feng Huang, Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Chen ZY participated in the design of this study, drafted the manuscript, and performed the statistical analysis; Zhang LF, Zhang YQ, Zhou Y, and Li XY carried out the study and collected data; Huang XF participated in the design of this study and made critical revision related to the important intellectual content of the manuscript; All authors read and approved the final manuscript.
Supported by Zhejiang National Science Foundation, No. LGF20H040010 and No. LY17H040004; and Zhejiang Bureau of Traditional Chinese Medicine, No. 2017ZA092.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee at Women’s Hospital School of Medicine, Zhejiang University, No. IRB-20200049-R.
Informed consent statement: The data are anonymous, and the requirement for informed consent was therefore waived.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Data sharing statement: Statistical code, and data set available from the corresponding author at (email: huangxiufeng@zju.edu.cn). Participants gave informed consent for data sharing but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiu-Feng Huang, MD, Chief Doctor, Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, No. 1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China. huangxiufeng@zju.edu.cn
Received: June 1, 2021
Peer-review started: June 1, 2021
First decision: June 25, 2021
Revised: June 26, 2021
Accepted: September 15, 2021
Article in press: September 15, 2021
Published online: December 16, 2021
Processing time: 191 Days and 23.6 Hours
Abstract
BACKGROUND

Deep endometriosis (DE) is the most aggressive subtype of endometriosis. The diagnosis may be challenging, and no biomarkers that can discriminate women with DE from those without DE have been developed.

AIM

To evaluate the role of blood hemostatic parameters and inflammatory indices in the prediction of DE.

METHODS

This case-control study was performed at the Women’s Hospital, Zhejiang University School of Medicine between January 2015 and December 2016. Women with DE and women with benign gynecologic disease (control group) eligible for gynecological surgery were enrolled. Routine plasma hemostatic parameters and inflammatory indices were obtained before surgery. Univariate and multivariate analysis were performed. Receiver operating characteristic (ROC) curves were generated, and areas under the curve (AUC) were calculated to assess the predictive values of the selected parameters.

RESULTS

A total of 126 women were enrolled, including 31 with DE and 95 controls. Plasma fibrinogen (Fg, P < 0.01), international normalized ratio (P < 0.05), and C-reactive protein levels (P < 0.01) were significantly higher in women with DE compared with controls. Plasma hemoglobin (HB) levels (P < 0.05) and shortened thrombin time (P < 0.05) were significantly lower in women with DE than in controls. Plasma Fg levels [adjusted OR (aOR) 2.12, 95%confidence interval (CI): 1.31-3.75] and plasma HB levels (aOR 0.48, 95%CI: 0.29-0.78) were significantly associated with DE (both P < 0.05). ROC analysis showed that the diagnostic value of Fg or HB alone for DE was limited. The AUC of the combination of both markers as a dual marker index was 0.773 with improved sensitivity (67.7%) and specificity (78.9%) at cutoffs of 3.09 g/L and 126 g/L, respectively.

CONCLUSION

The combination of Fg and HB was a reliable predictor of DE. A larger study is needed to confirm the findings.

Keywords: Deep endometriosis; Diagnosis; Fibrinogen; Hemoglobin; Inflammation

Core Tip: Deep endometriosis (DE) is the most aggressive subtype of endometriosis. Prompt diagnosis of DE is challenging, and developing new approaches for DE prediction before surgical intervention is of key importance for controlling the disease. Herein, we performed a case-control study to evaluate the role of plasma hemostatic parameters and inflammatory indices in predicting DE. Our results revealed that the combination of fibrinogen and hemoglobin had a good predictive value for DE before surgical intervention.