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Abstract
Background and Aims
Non-valvular atrial fibrillation (NVAF) patients face a 3–5 times greater risk of acute ischemic stroke (AIS) compared to those without NVAF. This study aims to establish a novel clinical prediction model for AIS in elderly patients with NVAF by incorporating relevant biomarker indicators.
Methods
A total of 301 individuals diagnosed with NVAF were selected for this investigation at the Third Affiliated Hospital of Anhui Medical University. Based on the presence of AIS, patients were categorized into two groups: the Stroke Cohort and the Non-Stroke Cohort. Predictor screening was performed using the least absolute shrinkage and selection operation (LASSO) regression algorithm. The binary logistic regression equation was applied to fit the model, followed by internal validation using the bootstrap resampling method (1000 times). Receiver operating characteristic (ROC) curve, calibration degree curve plots, and clinical decision curve analysis (DCA) were generated, respectively. Finally, a nomogram was constructed to present the prediction model.
Results
The final results of this study revealed that neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), lipoprotein(a) (Lp(a)), systolic pressure, history of stroke, hyperlipidemia were independent risk factors for AIS in elderly patients with NVAF (P<0.05). And the high-density lipoprotein cholesterol (HDL-C) was an independent protective factor (P<0.05). By incorporating these indicators, a nomogram prediction model for predicting AIS in elderly patients with NVAF was constructed. Comparative analysis between the nomogram predictive model and CHA2DS2-VASc score revealed that the AUC of the nomogram predictive model surpassed that of the CHA2DS2-VASc score (AUC: 0.881vs 0.850).
Conclusion
NLR, RDW, Lp(a), SP, history of stroke, hyperlipidemia, and HDL-C emerge as independent prognostic factors for acute ischemic stroke in elderly patients with non-valvular atrial fibrillation. The predictive utility of the nomogram model may potentially surpass that of the CHA2DS2-VASc scoring system.
Abbreviations
NVAF, Non-valvular atrial fibrillation; AIS, acute ischemic stroke; LASSO, least absolute shrinkage and selection operation; ROC, regression algorithm; Receiver operating characteristic; DCA, curve; Clinical decision curve analysis; NLR, neutrophil-to-lymphocyte ratio; RDW, red cell distribution width; Lp(a), lipoprotein(a); SP, systolic pressure; AUC, the area under the ROC curve; AF, Atrial fibrillation; TG, triglycerides; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; HCY, homocysteine; FBG, fasting blood glucose; UA, uric acid; SCr, serum creatinine; GFR, glomerular filtration rate; NC, neutrophil count; LC, lymphocyte count; PLT, platelet count; HCT, hematocrit; LAD, left atrial dimension; LVEDD, left ventricular end diastolic dimension; LVEF, left ventricular ejection fraction; MSE, minimizing mean squared error; IL-10, Interleukin; NIHSS, National Institutes of Health Stroke Scale; TIMI-AF, The Thrombolysis in Myocardial Infarction-Atrial Fibrillation score; ATRIA, Anticoagulation and Risk Factors in Atrial Fibrillation score.
Data Sharing Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. The data are not publicly available due to their containing information that could compromise the privacy of patients.
Ethics Approval and Consent to Participate
The study protocol and informed consent procedures were approved by the Ethics Committee of the Third Affiliated Hospital of Anhui Medical University. All methods were performed following the Declaration of Helsinki. Informed written consent for publication without direct personal identification details was obtained from all the participants.
Acknowledgments
The authors would like to extend their sincere thanks to MM F, YT H, and YZ for their contribution to reviewing this manuscript and the acquisition of data. We also extend our gratitude to JC G, YH, BF Z, and MM F for their contributions. We would like to express our gratitude and give credit to Ref 17 for proposing the ABC stroke risk score, which served as a valuable reference in our study.
Author Contributions
Jiongchao Guo and Yuan Zhou have made equal contributions and should be considered as a co-first authors. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors declare no conflicts of interest statement.