He Haohui, Guo Jun, Zhang Aidong
Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
Int J Cardiol. 2016 Oct 15;221:827-30. doi: 10.1016/j.ijcard.2016.07.145. Epub 2016 Jul 11.
Accurate risk stratification is important in the management of patients with non-valvular atrial fibrillation (NVAF). However, one cohort study demonstrated an annual ischemic stroke rate of 1.61% in the group of patients classified in "the true low risk" according to CHA2DS2-VASc. We aimed to find out more indicators and evaluate their abilities in predicting thromboembolic events (TE).
We assigned 58 patients with TE to the thrombosis group, and 157 patients without TE to the non-thrombosis group. The clinical parameters of these patients were subjected to univariate analysis and unconditioned logistic regression analysis for screening the risk factor, which was urine albumin (UA) according to the result. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off point of the UA. Then we formed the CHA2DS2-VASc-UA2 score and made a comparison with CHA2DS2-VASc score.
Mean UA of the thrombosis group was significantly higher than that of the non-thrombosis group (0.1g/L vs 0.0g/L, P<0.01). The results of unconditioned logistic regression analysis showed that OR of UA was 40.98 (95% CI: 3.58-468.88, P<0.01). The Area Under the Curve (AUC) of UA was 0.700 with an optimal cut-off point of 0.03g/L. ROC curve analysis result showed that AUC of CHA2DS2-VASc-UA2 score was larger than that of CHA2DS2-VASc score (0.873 vs 0.860, P<0.01).
UA≥0.03g/L is the independent predictive factor of TE for NVAF patients. And the CHA2DS2-VASc-UA2 score might perform better in predicting TE compared with the CHA2DS2-VASc score.
准确的风险分层对于非瓣膜性心房颤动（NVAF）患者的管理至关重要。然而，一项队列研究表明，根据CHA2DS2-VASc分类为“真正低风险”的患者组中，年度缺血性卒中发生率为1.61%。我们旨在找出更多指标并评估它们预测血栓栓塞事件（TE）的能力。
我们将58例发生TE的患者分配到血栓形成组，将157例未发生TE的患者分配到非血栓形成组。对这些患者的临床参数进行单因素分析和非条件逻辑回归分析以筛选危险因素，根据结果该危险因素为尿白蛋白（UA）。采用受试者工作特征（ROC）曲线确定UA的最佳截断点。然后我们构建了CHA2DS2-VASc-UA2评分，并与CHA2DS2-VASc评分进行比较。
血栓形成组的平均UA显著高于非血栓形成组（0.1g/L对0.0g/L，P<0.01）。非条件逻辑回归分析结果显示，UA的比值比（OR）为40.98（95%置信区间：3.58-468.88，P<0.01）。UA的曲线下面积（AUC）为0.700，最佳截断点为0.03g/L。ROC曲线分析结果显示，CHA2DS2-VASc-UA2评分的AUC大于CHA2DS2-VASc评分（0.873对0.860，P<0.01）。
UA≥0.03g/L是NVAF患者TE的独立预测因素。并且与CHA2DS2-VASc评分相比，CHA2DS2-VASc-UA2评分在预测TE方面可能表现更好。
