The Association of CHA2DS2-VASc Score and Blood Biomarkers with Ischemic Stroke Outcomes: The Belgrade Stroke Study

Abstract

BackgroundMany blood biomarkers have a positive association with stroke outcome, but adding blood biomarkers to the National Institutes of Health Stroke Scale (NIHSS) did not significantly improve its discriminatory ability. We investigated the association of the CHA2DS2-VASc score with unfavourable functional outcome (defined as a 30-day modified Rankin Scale [mRS] ≥3) in patients presenting with acute ischemic stroke (AIS), and examined whether the addition of blood biomarkers (troponin I [TnI], fibrinogen, C-reactive protein [CRP]) affects the model discriminatory ability.MethodsWe conducted an observational single-centre study of consecutive patients with AIS. All patients were admitted to hospital within 24 hours from the neurological symptoms onset.ResultsOf 240 patients (mean age 70.0±8.9 years), unfavourable 30-day outcome occurred in 92 (38.3%). Patients with mRS≥3 were older and more likely to have atrial fibrillation or other comorbidities (all p<0.001). They had higher levels of CRP, fibrinogen, TnI and higher CHA2DS2-VASc and CHADS2 scores (all p<0.05). The adjusted CHA2DS2-VASc score had excellent predictive ability for poor stroke outcome (c-statistic 0.982;95%CI,0.964–1.000, p<0.001). Whilst CRP had the highest sensitivity (83.7%), cardiac TnI was the most specific (97.3%) for prediction of poor stroke outcome (cut-off: >0.09µg/L). Compared with each of these biomarkers, CHA2DS2-VASc score had significantly better predictive ability for poor stroke outcome (c-statistic for CRP, Fibrinogen and TnI was 0.853;95%CI,0.802–0.895, 0.848;95%CI,0.796–0.891, and 0.792;95%CI,0.736–0.842, all p<0.001, respectively, versus 0.932;95%CI,0.892–0.960, p<0.001 for the CHA2DS2-VASc, all p for the comparisons<0.01). There was no significant difference in the predictive ability of the CHA2DS2-VASc score vs. combinations of the CHA2DS2-VASc and TnI or TnI, fibrinogen and CRP (z statistic 0.369, p = 0.7119; integrated discrimination index 0.00801 and 0.00172, respectively, both p>0.05).ConclusionsThe CHA2DS2-VASc score alone reliably predicts 30-day unfavourable outcome of stroke. Adding blood biomarkers to the CHA2DS2-VASc score did not significantly increase the predictive ability of the model.

Association Between Left Atrial Appendage Morphology Evaluated by Trans-Esophageal Echocardiography and Ischemic Cerebral Stroke in Patients With Atrial Fibrillation

“…30) However, this association between hsCRP and ischemic stroke found in univariate analysis in AF patients was lost after multivariate adjustment using the logistic regression model in our study. A similar finding was reported by Potpara, et al 31) where the CHA2DS2-VASc score reliably predicts a short-term, 30-day unfavorable outcome of acute ischemic stroke regardless of the presence or absence of AF, and that adding high-sensitivity TnI or fibrinogen or CRP, or all three biomarkers, to the CHA2DS2-VASc score does not further improve the prediction. Study limitations: First, the small number of patients included in this study is a major limitation.…”

CHA2DS2‐VASc scores for outcome prediction in acute ischaemic stroke

“…In stroke patients with nonvalvular AF, both higher CHADS 2 and CHA 2 DS 2 ‐VASc scores predicted a worse clinical outcome . But other studies of stroke patients reported only CHA 2 DS 2 ‐VASc score could predict an unfavourable 30‐day outcome and was useful for stratifying the risk of poor outcome at 3 months following stroke . Although studies have been carried out to investigate the possibility of expanding the use of the CHADS 2 and CHA 2 DS 2 ‐VASc scores from the original purpose of assessing risk of stroke in patients with AF to predict clinical outcomes of patients with acute ischaemic stroke, data from these studies were limited because the follow‐up periods were relatively short and no imaging evidence of infarction severity was reported …”

High CHA2DS2−VASc score predicts left atrial thrombus or spontaneous echo contrast detected by transesophageal echocardiography

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CHA 2 DS 2 -VASc score alone has been reported to predict 30-day risk of stroke reliably [1]. A CHA 2 DS 2 -VASc score of 0 could relatively precisely prompt truly low incidence of stroke, with an annual ischemic stroke rate of approximately 1% [2].

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