Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 62247, Taiwan.
School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan.
Medicina (Kaunas). 2020 Feb 12;56(2):73. doi: 10.3390/medicina56020073.
The aim of this retrospective cohort study was to develop a new score (RA-CHADSV) (rheumatoid arthritis - congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, and vascular disease), modified from the CHADS-VASc score (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke/transient ischemic attack (doubled), vascular disease, age 65-74 years, and female), in predicting the risk of ischemic stroke in rheumatoid arthritis (RA) patients without atrial fibrillation (AF).
Using the Taiwan's National Health Insurance Research Database, 592 patients with RA diagnosed between 2000 and 2002 were identified and followed until first occurrence of ischemic stroke or the last available date in the database. Incidence rate ratios (IRR) of ischemic stroke for the CHADS-VASc score were calculated using Poisson regression models. A new prediction score RA-CHADSV was developed using multiple logistic regression analysis with bootstrap validation.
The area under the receiver operating characteristic curve of the newly developed RA-CHADSV score and the CHADS-VASc score were 0.73 (95% confidence interval (CI) 0.64-0.82) and 0.70 (95% CI 0.61-0.79), respectively. The RA-CHADSV score was significantly associated with a higher ischemic stroke incidence in the patients who scored ≥1 (adjusted IRR 7.39, < 0.001).
A simplified RA-CHADSV score, with comparable efficiency as the CHADS-VASc score, but easier to use clinically was developed for predicting the risk of ischemic stroke among non-AF RA patients.
本回顾性队列研究的目的是开发一种新的评分系统（RA-CHADSV）（类风湿关节炎-充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、卒中和短暂性脑缺血发作/血栓栓塞、血管疾病），该评分系统是对 CHADS-VASc 评分（充血性心力衰竭、高血压、年龄≥75 岁（翻倍）、糖尿病、卒中和短暂性脑缺血发作（翻倍）、血管疾病、年龄 65-74 岁、女性）的修改，用于预测无房颤（AF）的类风湿关节炎（RA）患者发生缺血性卒中的风险。
利用台湾全民健康保险研究数据库，确定了 592 例 2000 年至 2002 年间确诊的 RA 患者，并随访至首次发生缺血性卒中或数据库中最后一个可获得的日期。使用泊松回归模型计算 CHADS-VASc 评分的缺血性卒中发生率的比率（IRR）。采用 bootstrap 验证的多因素逻辑回归分析建立新的预测评分 RA-CHADSV。
新开发的 RA-CHADSV 评分和 CHADS-VASc 评分的受试者工作特征曲线下面积分别为 0.73（95%置信区间[CI]0.64-0.82）和 0.70（95%CI0.61-0.79）。RA-CHADSV 评分≥1 分的患者发生缺血性卒中的风险显著升高（校正 IRR7.39，<0.001）。
开发了一种简化的 RA-CHADSV 评分，与 CHADS-VASc 评分具有相当的预测效率，但在临床上更容易使用，用于预测非 AF-RA 患者发生缺血性卒中的风险。
