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). 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. 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 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 =1.40× 10 − 2 ; warfarin vs rivaroxaban p =3.00× 10 − 3 ). 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.