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

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:

• NVAF
• CCE
• PLR
• CHA₂DS₂-VAS_c score
• LASSO model

Patient Privacy Protection Statement

We desensitized all the data that can be used to identify patient personal information, such as their names, hospitalization ID and telephone numbers, to protect the privacy of patients.

Data Sharing Statement

The authors declare that all data supporting the findings of this study are available within the article or from the corresponding author (Gang Wang).

Ethical Approval and Consent to Participate

The studies involving human participants were reviewed and approved by the Medical Ethics Committee, Zhongnan Hospital of Wuhan University (2022157K). As this study is retrospective and presents no risk of harm to subjects, and no privacy of individuals is exposed, informed consent was waived. All procedures adhered to the ethical standards and the Helsinki Declaration (as revised in 2013).

Author Contributions

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 that they have no competing interest in this work.

Additional information

Funding

There is no funding to report.