Prognostic Value of Platelet-to-Lymphocyte Ratio Combined with CHA2DS2-VASc Score for Nonvalvular Atrial Fibrillation Induced Cardiogenic Cerebral Embolism

Qian Fan; Ling Gao; Zhiquan Wang; Fabrice Yves Ndjana Lessomo; Gang Wang

doi:10.2147/JIR.S431149

Prognostic Value of Platelet-to-Lymphocyte Ratio Combined with CHA₂DS₂-VAS_c Score for Nonvalvular Atrial Fibrillation Induced Cardiogenic Cerebral Embolism

J Inflamm Res. 2023 Dec 6:16:5937-5947. doi: 10.2147/JIR.S431149. eCollection 2023.

Authors

Qian Fan^#¹, Ling Gao^#¹, Zhiquan Wang^#², Fabrice Yves Ndjana Lessomo², Gang Wang¹

Affiliations

¹ Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, People's Republic of China.
² Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.

^# Contributed equally.

Abstract

Aim: To determine the predictive significance of the platelet-to-lymphocyte ratio (PLR) combined with the CHA₂DS₂-VAS_c score for cardiogenic cerebral embolism (CCE) in patients with nonvalvular atrial fibrillation (NVAF).

Methods: A total of 553 patients with NVAF were included in this retrospective study. The general data, PLR, CHA₂DS₂-VAS_c score and echocardiography indicators were compared. The risk factors for CCE and the predictive value of PLR and CHA₂DS₂-VAS_c were analyzed. Stratified analysis was performed based on the cut-off value. Least absolute shrinkage and selection operator (LASSO) regression analysis was utilized to build a model. The relationship between risk score and different anticoagulants was evaluated.

Results: Multiple regression analysis showed hypertension (OR=3.95, 95% CI=2.12-7.35, p=1.40×10^-5), diabetes mellitus (OR=2.95, 95% CI=1.57-5.58, p=7.65×10^-4), PLR (OR=1.01, 95% CI=1.00-1.01, p<10^-6), creatinine level (OR=1.01, 95% CI=1.00-1.02, p=7.44×10^-3), left atrial diameter (LAD) (OR=1.90, 95% CI=1.13-3.19, p=1.51×10^-2), ejection fraction (EF) (OR=0.93, 95% CI=0.87-0.98, p=8.06×10^-3) and CHA₂DS₂-VAS_c score (OR=3.79, 95% CI=2.95-4.85, p<10^-6) were independent risk factors for CCE. A one-way linear analysis also showed the above seven indexes were significantly correlated with CCE (F=56.4, p<10^-6). The area under the receiver operating characteristic (ROC) curve of PLR and CHA₂DS₂-VAS_c score was 0.760 (95% CI:0.721-0.800), and 0.855 (95% CI: 0.824-0.886), respectively. Pearson correlation analysis showed that PLR was correlated with CHA₂DS₂-VAS_c score (r=0.331, p<10^-6). Stratified analysis indicated there was a positive correlation between different risk group (p<10^-6). Using the LASSO model, a composite indicator displayed differential power for distinguishing CCE with an AUC value of 0.884 (95% CI: 0.857-0.911). Patients with dabigatran and rivaroxaban exhibited higher risk score than those with warfarin (warfarin vs dabigatran, p=1.40×10^-2; warfarin vs rivaroxaban p=3.00×10^-3).

Conclusion: PLR and CHA₂DS₂-VAS_c score are independent risk factors for CCE with NVAF, and the combination of the two indices can improve the prediction of CCE.

Keywords: CCE; CHA2DS2-VASc score; LASSO model; NVAF; PLR.

Grants and funding

There is no funding to report.