Combined Predictive Value of Neutrophil-to-Lymphocyte Ratio and CHA2DS2-VASc Score for Cardiogenic Cerebral Embolism in NVAF Patients.

AIM

This study aimed to determine the identification role of neutrophil-to-lymphocyte ratio (NLR) combined with CHA2DS2-VASC score for cardiogenic cerebral embolism (CCE) in acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF).

METHODS

From January 2019 to August 2024, a total of 402 acute ischemic stroke patients with NVAF were enrolled in this retrospective study and were divided according to the occurrence of CCE into the CCE or non-CCE groups. Clinical data were collected from both groups, which included demographic data, medical history, CHA2DS2-VASC score, and laboratory tests (blood cell counts and blood biochemistry indicators). A predictive model based on blood indexes and the CHA2DS2-VASC score was constructed using least absolute shrinkage and selection operator (LASSO) regression analysis.

RESULTS

Multiple regression analysis showed that the CHA2DS2-VASc score (OR = 2.95, 95% CI = 2.19-3.99, p < 0.001), white blood count (OR = 1.43, 95% CI = 1.15-1.78, p = 0.001), neutrophil-to-lymphocyte ratio (NLR; OR = 1.63, 95% CI = 1.29-2.05, p < 0.001), and D-dimer levels (OR = 1.56, 95% CI = 1.15-2.12, p = 0.005) were independent risk factors for CCE. Spearman correlation analysis showed that NLR and the CHA2DS2-VASc score had a significant positive correlation (R = 0.449, p < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for NLR and the CHA2DS2-VASc score were 0.869 (95% CI = 0.843-0.901) and 0.859 (95% CI = 0.820-0.898), respectively. A composite index for distinguishing CCE risk was constructed using LASSO regression analysis, which yielded an AUC value of 0.924 (95% CI = 0.898-0.950).

CONCLUSION

NLR is an independent risk factor for CCE in NVAF patients, and combining it with CHA2DS2-VASC score provides a more useful composite index for identifying the CCE risk of patients with NVAF. This composite score may serve as a promised tool in clinical workflows, and it could even contribute to individualized anticoagulation strategies by identifying high-risk patients who may benefit from more positive preventive methods.