Clinical Application Of ABCD~2 Score Combined With Plasma Fibrinogen In The Prediction Of Cerebral Ischemia Events In Dizziness Patients

BackgroundDizziness is definite as the impairment of spatial perception and stability.It can be classified into vertigo,syncope,imbalance and/or instability and non-specific top-heavy.The etiology of dizziness can be covered by multidisciplinary,such as neurology,cardiology,otorhinolaryngology,psychiatry,etc.The incidence of dizziness is high.About 15-35%of people have experiences of dizziness in their lives.For most cases,dizziness is caused by not-fatal diseases,but in some extremely cases,the causes of dizziness may endanger the patient’s life,such as stroke,that is called malignant dizziness.In clinical practice,doctors should be alert to malignant dizziness.In patients with dizziness,symptoms are always changeable,so doctors can’t get accurate medical history.It will lead to unnecessary examinations and waste of medical resources if we prescribe the overall examination.Therefore,it is significant to find a reliable assessment method to accurately and quickly detect the cause of the dizziness.The ABCD2 score is widely used for evaluating the short-term risk of acute ischemic stroke in patients with transient ischemic stroke(TIA).It is composed of age(A),blood pressure(B),clinical features(C),duration(D)and diabetes(D2).Previous studies have found that ABCD2 score has ability to quickly screen out patients with dizziness due to stroke.Cranial CT scan has high diagnostic value for intracerebral hemorrhage.But the diagnosis of ischemic stroke mostly depends on magnetic resonance imaging(MRI).This examination often takes long time and is not suitable for ED.Some patients with posterior circulation TIA can also present dizziness.TIA is a special alert for stroke.Finding an efficient method to identify the dizziness patients with cerebral ischemic events is imperative.Plasma fibrinogen(Fib)is an acute phase protein,which is closely related to ischemic stroke.As a part of coagulation function,Fib is usually regarded as a routine examination for patients.It is convenient for data acquisition and suitable for wide application.ObjectivesTo investigate the etiology and the distribution of cerebrovascular risk factors of dizziness patients in the neurology department;to explore the diagnostic ability in cerebral ischemia events of ABCD2 score in the dizziness patients;to know the difference of plasma Fib concentration in the dizziness patients with different causes;to explore the diagnostic ability in cerebral infarction of ABCD2 score with plasma Fib level in the dizziness patients.MethodsA retrospective case analysis method was used to include 300 hospitalized patients who met the inclusion criteria from June 2016 to September 2017 in the department of Neurology.A detailed collection of patient records,including gender,age,past medical history(including hypertension,diabetes,coronary heart disease,smoking,drinking alcohol and other risk factors of stroke),clinical manifestations,duration,neurological signs,results of cranial CT and(or)MRI,and the results of important laboratory tests(Fib,blood glucose,etc.),and diagnosis.All the included patients completed the ABCD2 score and plasma fib examination.According to the final diagnosis,the patients were divided into three groups:the acute cerebral infarction group,the transient ischemic attack(TIA)group and the non cerebrovascular disease group.SPSS 22 statistical software was used to analyze the data.The data of multiple groups were compared by ANOVA.After that,LSD test was used for comparison between each group.Count data were compared using theχ2 test.P<0.05(bilateral test)was considered as a statistically significant difference.The value of ABCD2 score in prediction of ischemic events in dizziness patients,and the reliability analysis of the ABCD2 score combined with the plasma Fib concentration in the diagnostic value of cerebral infarction in the dizziness patients were completed by receiver operating characterstic(ROC)curve.Results1.This study collects 300 cases of standard patients.All the included patients were divided into three groups according to the final diagnosis:acute cerebral infarction group,64 cases(21.3%),TIA group,89 cases(29.7%),and non cerebrovascular disease group,147 cases(49%).The majority of patients in non cerebrovascular disease group is benign paroxysmal positional vertigo(n=97,accounting for 67%).2.Among all the dizziness patients,there were 148 males and 152 females,aged between 19-94 years old,with an average age of 64.77 ±14.29 years.In the comparison of the risk factors of cerebrovascular disease,the incidence of male,hypertension,diabetes and smoking in the acute cerebral infarction group was significantly different among the TIA group,the acute ischemic stroke group and the non cerebrovascular disease group.3.The ABCD2 scores of non cerebral vascular disease group,TIA group and acute cerebral infarction group increased sequentially.The incidence of cerebral infarction gradually increased among different risk levels.4.The Fib concentration in patients with acute cerebral infarction was significantly higher than that in TIA group and non cerebrovascular disease group.The Fib concentration in TIA group was higher than that in non cerebrovascular disease group.5.The prediction capacity of ABCD2 score in diagnosing cerebral ischemia events in dizziness patients is moderate.6.ABCD2 score combined with plasma Fib in prediction of acute cerebral infarction in the dizziness patients’ areas under the curve(AUC)were greater than using ABCD2 score alone.Conclusions1.ABCD2 score has ability to identify patients with dizziness due to cerebral ischemia events.2.ABCD2 score has the ability of risk stratification for patients with dizziness.The higher ABCD2 score,the higher the risk of cerebral infarction.3.ABCD2 score combined with plasma Fib is more valuable than that ABCD2 score alone in evaluating the risk of cerebral infarction in dizziness patients.