Prognostic Impact of Atrial Fibrillation Pattern and Other Clinical Biomarkers in Patients with Stroke Admitted in a Tertiary Hospital in Cebu City from 2015-2022

Overview

Journal Acta Med Philipp

Specialty General Medicine

Date 2024 Jul 5

PMID 38966615

Authors

Sofia Maria S Im

Ma Teresa A Canete

Affiliations

Soon will be listed here.

Abstract

Background: The effect of atrial fibrillation (AF) patterns and clinical biomarkers among patients with AF-related stroke is still controversial.

Objectives: The objective of this study is to determine the association of the pattern of AF and markers on routine blood tests with the outcome of patients after an AF-related stroke.

Methods: This is a retrospective cohort study of patients with stroke and AF admitted in a tertiary hospital in Cebu City from 2015-2022. Patients' baseline characteristics, laboratory tests, ECG, and radiologic data were collected. Descriptive statistics such as mean and frequency were computed. The Kaplan-Meier method and the log-rank test were used to calculate the incidence time. The Cox regression analysis was used to determine factors associated with survival. A stepwise regression technique was used in model building.

Results: The mortality rate of patients with AF-related stroke was 0.02. A Kaplan Meier survival estimate shows that patients with paroxysmal AF have better survival. Upon model building of variables, age, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet count, low density lipid cholesterol (LDL-C), and pattern of AF were predictive of mortality in patients with AF-related stroke.

Conclusions: Among AF-related stroke patients admitted at a tertiary hospital in Cebu City, pattern of AF, age, RDW, NLR, platelet count, and LDL-C were associated with mortality. The parameters associated with increased mortality could be easily assessed using an ECG, CBC, and lipid profile. These are all readily available and cost-efficient.

References

Vanassche T, Lauw M, Eikelboom J, Healey J, Hart R, Alings M . Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES. Eur Heart J. 2014; 36(5):281-7a. DOI: 10.1093/eurheartj/ehu307. View

Olsen T, Christensen R, Kammersgaard L, Andersen K . Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study. Stroke. 2007; 38(10):2646-51. DOI: 10.1161/STROKEAHA.107.490292. View

Ren J, Yang Y, Zhu J, Wu S, Wang J, Zhang H . Type of atrial fibrillation and outcomes in patients without oral anticoagulants. Clin Cardiol. 2020; 44(2):168-175. PMC: 7852164. DOI: 10.1002/clc.23519. View

Song S, Hua C, Dornbors 3rd D, Kang R, Zhao X, Du X . Baseline Red Blood Cell Distribution Width as a Predictor of Stroke Occurrence and Outcome: A Comprehensive Meta-Analysis of 31 Studies. Front Neurol. 2019; 10:1237. PMC: 6901990. DOI: 10.3389/fneur.2019.01237. View

Wang Y, Ma C, Du X, He L, Li J, Wang G . Thromboembolic risks associated with paroxysmal and persistent atrial fibrillation in Asian patients: a report from the Chinese atrial fibrillation registry. BMC Cardiovasc Disord. 2019; 19(1):283. PMC: 6898943. DOI: 10.1186/s12872-019-1260-7. View

Goette A, Borof K, Breithardt G, Camm A, Crijns H, Kuck K . Presenting Pattern of Atrial Fibrillation and Outcomes of Early Rhythm Control Therapy. J Am Coll Cardiol. 2022; 80(4):283-295. DOI: 10.1016/j.jacc.2022.04.058. View

Han K, Su X, Liu J, Yao F, Lu F . Red Cell Distribution Width as a Novel Marker for Different Types of Atrial Fibrillation in Low and High Altitude. Cardiol Res Pract. 2019; 2019:6291964. PMC: 6431478. DOI: 10.1155/2019/6291964. View

Shang L, Zhang L, Guo Y, Sun H, Zhang X, Bo Y . A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation. Front Cardiovasc Med. 2021; 8:682538. PMC: 8281032. DOI: 10.3389/fcvm.2021.682538. View

Storhaug H, Norvik J, Toft I, Eriksen B, Lochen M, Zykova S . Uric acid is a risk factor for ischemic stroke and all-cause mortality in the general population: a gender specific analysis from The Tromsø Study. BMC Cardiovasc Disord. 2013; 13:115. PMC: 4029378. DOI: 10.1186/1471-2261-13-115. View

10.

Perera K, Vanassche T, Bosch J, Swaminathan B, Mundl H, Giruparajah M . Global Survey of the Frequency of Atrial Fibrillation-Associated Stroke: Embolic Stroke of Undetermined Source Global Registry. Stroke. 2016; 47(9):2197-202. DOI: 10.1161/STROKEAHA.116.013378. View

11.

Tsivgoulis G, Vassilopoulou S, Spengos K . Impact of anticoagulation on poststroke mortality in ischemic stroke patients with atrial fibrillation. Stroke. 2007; 38(7):e61. DOI: 10.1161/STROKEAHA.107.484030. View

12.

Yang M, Pan Y, Li Z, Yan H, Zhao X, Liu L . Platelet Count Predicts Adverse Clinical Outcomes After Ischemic Stroke or TIA: Subgroup Analysis of CNSR II. Front Neurol. 2019; 10:370. PMC: 6473473. DOI: 10.3389/fneur.2019.00370. View

13.

Hagii J, Metoki N, Saito S, Shiroto H, Sasaki S, Takahashi K . Persistent or permanent atrial fibrillation is associated with severe cardioembolic stroke in patients with non-valvular atrial fibrillation. Thromb J. 2021; 19(1):22. PMC: 8011096. DOI: 10.1186/s12959-021-00276-9. View