Integrated Inflammatory markers in the assessment of left atrial appendage thrombosis risk in patients with non-valvular atrial fibrillation

In patients with non‑valvular atrial fibrillation (NVAF), systemic inflammation may contribute to the formation of a thrombogenic substrate in the left atrial appendage (LAA) through platelet activation, coagulation cascade activation, endothelial dysfunction, and atrial remodeling. Therefore, promising markers for assessing inflammatory activity include not only C‑reactive protein (CRP) but also integrated hematological indices such as neutrophil‑to‑lymphocyte ratio (NLR), platelet‑to‑lymphocyte ratio (PLR), systemic immune‑inflammation index (SII), and pan‑immune‑inflammation value (PIV). Objective — to assess the levels of integrated inflammatory markers for predicting the risk of thrombus formation in the LAA in patients with NVAF. Materials and methods. A total of 82 patients with NVAF were examined, with a mean age of 64.94±10.85 years; 56.1% were male. All patients underwent transesophageal echocardiography and assessment of CRP and fibrinogen levels. Additionally, NLR, PLR, SII, and PIV were calculated. Results. The calculated median CRP level was 6.45 mg/L. Patients were divided into two groups: Group I included 41 patients with CRP ≤ 6.45 mg/L, while Group II included 41 patients with CRP > 6.45 mg/L. Arterial hypertension, type 2 diabetes mellitus, and obesity were more frequently observed in Group II, and the CHA2DS2‑VA score was also higher. A thrombus or echocardiographic markers of a high risk of thrombus formation in the LAA were detected significantly more frequently in Group II than in Group I (43.9% vs. 21.95%, p=0.0344). Pearson correlation analysis demonstrated positive correlations between CRP levels and NLR (p=0.021), SII (p=0.002), PIV (p=0.0001), and fibrinogen levels (p=0.0001). ROC analysis demonstrated that a CRP level > 6.8 mg/L had satisfactory discriminatory ability for predicting the presence of a thrombus/thrombogenic milieu in the LAA (AUC=0.687, sensitivity — 66.7%, specificity — 70.9%, p=0.0034), whereas NLR demonstrated the best predictive ability, with an optimal cut‑off value > 2.07 (AUC=0.732, sensitivity 85.2%, specificity 52.7%, p=0.0001). SII and PIV had statistically significant predictive value (AUC=0.665, sensitivity — 63.0%, specificity — 69.1%, p=0.0114, and AUC=0.651, sensitivity — 55.6%, specificity — 77.6%, p=0.0236, respectively). Conclusions. Informative predictive markers for assessing the risk of thrombus formation in the LAA in patients with NVAF include a CRP level > 6.8 mg/L (p=0.0034), NLR > 2.07 (p=0.0001), SII > 0.665 (p=0.0114), and PIV > 304.82 (p=0.0236).