Sab Marc, Chelala Dania, Aoun Mabel, Azar Rabih, Abdel Massih Tony
Saint-Joseph University, Beirut, Lebanon.
Hotel-Dieu de France Hospital, Beirut, Lebanon.
Clin Kidney J. 2022 Dec 9;16(3):596-602. doi: 10.1093/ckj/sfac260. eCollection 2023 Mar.
In the general population, the CHADS-VASC and the HAS-BLED scores are helpful to predict cerebrovascular events and hemorrhage in patients with atrial fibrillation (AF). However, their predictive value remains controversial in the dialysis population. This study aims to explore the association between these scores and cerebral cardiovascular events in hemodialysis (HD) patients.
This is a retrospective study including all HD patients treated between January 2010 and December 2019 in two Lebanese dialysis facilities. Exclusion criteria are patients younger than 18 years old and patients with a dialysis vintage less than 6 months.
A total of 256 patients were included (66.8% men; mean age 69.3 ± 13.9 years). The CHADS-VASc score was significantly higher in patients with stroke (= .043). Interestingly, this difference was significant in patients without AF (= .017). Using receiver operating curve analysis, CHADS-VASc score had an area under the curve (AUC) of 0.628 [95% confidence interval (CI): 0.539-0.718) and the best cut-off value for this score was 4. The HAS-BLED score was also significantly higher in patients with a hemorrhagic event ( < .001). AUC for HAS-BLED score was 0.756 (95% CI: 0.686-0.825) and the best cut-off value was also 4.
In HD patients, CHADS-VASc score can be associated with stroke and HAS-BLED score can be associated with hemorrhagic events even in patients without AF. Patients with a CHADS-VASc score ≥4 are at the highest risk for stroke and adverse cardiovascular outcomes, and those with a HAS-BLED score ≥4 are at the highest risk for bleeding.
在普通人群中，CHADS-VASC和HAS-BLED评分有助于预测心房颤动（AF）患者的脑血管事件和出血情况。然而，它们在透析人群中的预测价值仍存在争议。本研究旨在探讨这些评分与血液透析（HD）患者脑血管事件之间的关联。
这是一项回顾性研究，纳入了2010年1月至2019年12月在黎巴嫩两家透析机构接受治疗的所有HD患者。排除标准为年龄小于18岁的患者以及透析龄小于6个月的患者。
共纳入256例患者（男性占66.8%；平均年龄69.3±13.9岁）。中风患者的CHADS-VASc评分显著更高（P = 0.043）。有趣的是，在无AF患者中这种差异也很显著（P = 0.017）。采用受试者工作特征曲线分析，CHADS-VASc评分的曲线下面积（AUC）为0.628 [95%置信区间（CI）：0.539 - 0.718]，该评分的最佳截断值为4。出血事件患者的HAS-BLED评分也显著更高（P < 0.001）。HAS-BLED评分的AUC为0.756（95% CI：0.686 - 0.825），最佳截断值同样为4。
在HD患者中，即使在无AF的患者中，CHADS-VASc评分也可能与中风相关，HAS-BLED评分可能与出血事件相关。CHADS-VASc评分≥4的患者发生中风和不良心血管结局的风险最高，而HAS-BLED评分≥4的患者出血风险最高。
