Int J Arrhythm.  2020 Sep;21(3):e10. 10.1186/s42444-020-00018-4.

Prognostic value of routine blood tests along with clinical risk factors in predicting ischemic stroke in non‑valvular atrial fibrillation: a prospective cohort study

• Yang S
• Cha M
• Kwak S
• Kwon S
• Lee S
• Park J
• Choi Y
• Moon I
• Lee E
• Lee S
• Choi E
• Oh S

• KMID: 2507229
• DOI: http://doi.org/10.1186/s42444-020-00018-4

Abstract

Background
In patients with atrial fibrillation (AF), most biomarkers are still of limited use due to cost-effectiveness and complexity in clinical practice.
Hypotheses
Biomarkers from routine blood tests improve the current risk stratification in AF patients.
Methods
This prospective study enrolled 600 patients diagnosed with non-valvular AF, of whom 537 were analyzed. Platelet count; platelet distribution width (PDW); red cell distribution width (RDW); and creatinine, D-dimer, and troponin I levels were measured at enrollment.
Results
During the mean follow-up period (2.2 ± 0.6 years), 1.9% patients developed ischemic stroke. According to the optimal cutoff of each biomarker, the risk of ischemic stroke was higher in patients with RDW ≥ 13.5%, creatinine ≥ 1.11 mg/dL, or PDW ≥ 13.2% (significant biomarkers; P value: < 0.01, 0.04, or 0.07, respectively). These 3 significant biomarkers had higher information gain than clinical risk factors in predicting ischemic stroke. The cumulative incidence of ischemic stroke was 1.2%, 1.1%, 8.4%, and 40.0% in patients with 0, 1, 2, and 3 significant biomarkers, respectively (P-for-trend < 0.001). Patients with  ≥ 2 significant biomarkers had a significantly higher risk of ischemic stroke than those with  < 2 significant biomarkers (adjusted hazard ratio 11.5, 95% confidence interval 3.3–40.2, P < 0.001). The predictability for ischemic stroke was significantly improved when  ≥ 2 significant biomarkers were added to the CHA₂DS₂–VASc score (area under the curve 0.790 vs. 0.620, P = 0.043).
Conclusion
Routine blood tests can provide better risk stratification of AF along with clinical risk factors.

Keyword

Atrial fibrillation; Biomarkers; Stroke; Thromboembolism