入院前 CHADS2 和 CHA2DS2-VASc 评分与早期神经恶化的关系。

Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening.

机构信息

Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.

Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.

出版信息

Cerebrovasc Dis. 2021;50(3):288-295. doi: 10.1159/000513396. Epub 2021 Feb 15.

DOI:10.1159/000513396

PMID:33588410

Abstract

BACKGROUND

Stroke risk scores (CHADS2 and CHA2DS2-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke.

OBJECTIVE

The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF.

METHODS

We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS2 and CHA2DS2-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission.

RESULTS

A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA2DS2-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04-1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA2DS2-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA2DS2-VASc (aOR = 1.20, 95% CI = 1.04-1.38) and CHADS2 scores (aOR = 1.24, 95% CI = 1.01-1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END.

CONCLUSIONS

High CHA2DS2-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

摘要

背景

中风风险评分（CHADS2 和 CHA2DS2-VASc）不仅可以预测房颤（AF）患者中风的风险，还与中风后的预后相关。

目的

本研究旨在评估中风风险评分与伴有 AF 的缺血性中风患者早期神经功能恶化（END）之间的关系。

方法

我们纳入了 2013 年 1 月至 2015 年 12 月连续收治的伴有 AF 的缺血性中风患者。采用既定评分系统计算 CHADS2 和 CHA2DS2-VASc 评分。END 定义为入院后 72 小时内 NIHSS 总分增加≥2 分或运动 NIHSS 评分增加≥1 分。

结果

共纳入 2099 例伴有 AF 的缺血性中风患者。多变量分析显示，在校正混杂因素后，CHA2DS2-VASc 评分（调整优势比[aOR] = 1.17，95%置信区间[CI] = 1.04-1.31）与 END 显著相关。初始 NIHSS 评分、抗凝药物的使用和颅内动脉粥样硬化（ICAS）也与 END 密切相关，独立于 CHA2DS2-VASc 评分。根据 ICAS 的存在进行多变量分析显示，CHA2DS2-VASc 评分（aOR = 1.20，95% CI = 1.04-1.38）和 CHADS2 评分（aOR = 1.24，95% CI = 1.01-1.52）与 END 均密切相关，仅在伴有 ICAS 的患者中。在不伴有 ICAS 的患者中，两种风险评分均与 END 无关。