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

Aim: To determine the predictive significance of the platelet-to-lymphocyte ratio (PLR) combined with the CHA(2)DS(2)-VAS(c) score for cardiogenic cerebral embolism (CCE) in patients with nonvalvular atrial fibrillation (NVAF).<br />Methods: A total of 553 patients with NVAF were included in this retrospective study. The general data, PLR, CHA(2)DS(2)-VAS(c) score and echocardiography indicators were compared. The risk factors for CCE and the predictive value of PLR and CHA(2)DS(2)-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.<br />Results: Multiple regression analysis showed hypertension (OR=3.95, 95% CI=2.12- 7.35, p=1.40x 10(- 5)), diabetes mellitus (OR=2.95, 95% CI=1.57- 5.58, p=7.65x 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=7.44x 10(- 3)), left atrial diameter (LAD) (OR=1.90, 95% CI=1.13- 3.19, p=1.51x 10(- 2)), ejection fraction (EF) (OR=0.93, 95% CI=0.87- 0.98, p=8.06x 10(- 3)) and CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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=1.40x 10(- 2); warfarin vs rivaroxaban p=3.00x 10(- 3)).<br />Conclusion: PLR and CHA(2)DS(2)-VAS(c) score are independent risk factors for CCE with NVAF, and the combination of the two indices can improve the prediction of CCE.