Investigation of the prognostic value of cha2ds2vasc score in acute ischemic stroke patients without atrial fibrillation

Objective: Stroke is a common and fatal neurological disease. Stroke is the third leading cause of death after coronary artery disease and all types of cancer worldwide. It is the most important cause of morbidity and long term disability in the adult age. Approximately %85 of the stroke is ischemic origin. The recent studies demonstrated that CHA2DS2VASc score closely related to the severity and prognosis of stroke besides its predictive role for ischemic stroke risk in patients with atrial fibrillation (AF). However, the relationship of CHA2DS2VAScscore with prognostic parameters such as ischemic stroke risk, severity of stroke and in-hospital mortality in patients without AF is unknown. In this study, we aimed to investigate the prognostic value of CHA2DS2VASc score in acute ischemic stroke patients without AF. Methods:Two hundred and fifty patients who admitted to emergency department of our hospital with the diagnosis of acute ischemic stroke and without AF were enrolled to the study between September 2017 and February 2018.CHA2DS2VAScscore, admission and discharge NIHSS score, severity of stroke (based on NIHSS), discharge and 3. month Barthell index (BI) and modified Rankin scale (mRS), cerebral infarct volume of patients were calculated. Patients were divided into 2 groups according to in-hospital mortality: those with in-hospital mortality (27 patients) and those without (223 patients). Results: The mean age of the patients was 69.6 ± 12.3 years and there were 110 (44 %) female and 140 (56 %) male patients. 162 of them had( 64,8 %) hypertension (HT), 80 of them had (32 %) diabetes mellitus (DM), 27 of them had (10,8 %) heart failure (HF) and 54 of them had (21,6 %) peripheral artery disease (PAD) history. Mean age was 75,6 ± 11,3 years in in-hospital mortality (+) group and 68.8 ± 12.2 years in in-hospital mortality (-) group (p = 0.006). HT (p = 0.019), DM (p = 0.001), HF (p < 0.001), PAD (p = 0.002), CHA2DS2VASc score (p < 0.001), NIHSS score (p < 0.001), severity of stroke (p < 0.001), mRS (p < 0.001) and SİV (p < 0.001) were statistically significantly higher whereas LVEF (p = 0.005) and BI (p < 0.001) were statistically significantly lower in-hospital mortality (+) group. There was a statistically significantly positive correlation of CHA2DS2VASc score with NIHSS score (r = 0.389; p <0.001), severity of stroke (r = 0,417; p < 0.001), mRS (r = 0,362; p < 0.001) and SIV (r = 0,214; p < 0.001) whereas a statistically significantly negative correlation was found BI (r = - 0,371; p < 0.001). In multivariate logistic regression analysis, we found that age (OR: 1.134; %95 CI: 1.057 – 1.205; p = 0.001), CHA2DS2VASc score (OR: 4.113; %95 CI: 2.065 – 7.659; p < 0.001) and NIHSS score (OR: 1.375; %95 CI: 1.078 – 1.755; p = 0.012) were independent predictors of in-hospital mortality in patients with acute ischemic stroke. Finally, in Kaplan-Meier survival analysis, in-hospital mortality was significantly higher in patients with CHA2DS2VASc score ≥ 6 (log rank p <0.001). Conclusion: We demonstrated for the first time that the CHA2DS2VASc score was an independent predictor of in-hospital mortality in acute ischemic stroke patients without AF. Our study was the first study that designed for this aim and we showed that the CHA2DS2VASc score could be used as a simple but powerful tool to help predict the adverse outcomes in acute ischemic stroke patients. We need further studies in this area.