| Objective:1.To explore the value of serum BNP and D-dimer in identifying cerebral embolism in patients with non-valvular atrial fibrillation(NVAF).2.To investigate the relationship between the levels of serum BNP and D-dimer and the prognosis of patients with NVAF cerebral embolism.Methods:1.Patients with acute cerebral infarction who first occurred during hospitalization in the Taizhou People,s Hospital from September 2019 to May 2020 were prospectively selected.The general baseline data of the patients were collected.BNP and D-dimer were measured within 24 hours of onset.According to the collected data,the patients were divided into cardiogenic embolism group,atherosclerosis group,small vessel occlusion group and unknown cause group.After that,all patients were divided into cardiogenic embolization group and non-cardiogenic embolization group.Binary Logistic regression and receiver operating characteristic curve(ROC curve)were used to estimate the risk factors of cardiogenic embolism and the accuracy of predicting this type.2.Patients with NVAF cerebral embolism who were hospitalized in the Taizhou People,s Hospital from September 2019 to May 2020 were prospectively selected.The general baseline data of the patients were collected.BNP and D-dimer were measured within 24 hours after onset.Three months after onset,the prognosis was evaluated according to the modified Rankin scale(m RS)follow-up.According to m RS score,the patients were divided into two groups: good prognosis group(m RS score 0-2)and poor prognosis group(m RS score 3-6).Binary Logistic regression and receiver operating characteristic curve(ROC curve)were used to explore the risk factors and effectiveness of poor prognosis.Results:1.A total of 286 patients were included in this study,including 120 cases(41.9%)in central embolization group,74 cases(25.9%)in atherosclerosis group,81 cases(28.3%)in arteriole occlusion group and 11 cases(3.9%)in unknown cause group.There were significant differences in age,smoking,morbidity of hypertension,prevalence of diabetes,admission NIHSS score,triglyceride,cholesterol,low density lipoprotein,D-dimer,red blood cell count and BNP among the four groups.After multiple comparisons,it was found that the age,D-dimer and BNP of patients with cardiogenic embolism were significantly higher than those of the other three groups.Univariate and multivariate logistics regression showed that BNP and D-dimer were risk factors for cardiogenic embolism.ROC curve analysis showed that BNP(AUC0.89995% CI 0.863-0.935(P < 0.001)and D-dimer(AUC 0.887,95% CI 0.846-0.927,P < 0.001)had higher accuracy in predicting cardiogenic embolism,and the cutoff values of BNP and D-dimer were 105.9pg/m L and 595μg/L.D-dimer and BNP combined to predict cardiogenic embolism and found that the accuracy of prediction(AUC 0.922 95% CI 0.89-0.54 P < 0.001)was further improved,with a sensitivity of100%,specificity of 86.6%,positive predictive value of 80.6%,negative predictive value of 100%,and accuracy of 91.4%.2.A total of 102 patients were included in this study,including 71 patients with good prognosis and 31 patients with poor prognosis.Univariate analysis showed that age,sex,admission NIHSS score,BNP and D-dimer were risk factors for poor prognosis.Multivariate analysis showed that admission NIHSS score(OR 1.205,95%CI 1.039-1.398,P = 0.014),D-dimer(OR 1.205,95% CI 1.039-1.398,P = 0.04),BNP(OR 1.035,95% CI 1.016-1.053,P < 0.001)were still risk factors for poor prognosis.ROC curve analysis showed that BNP(AUC 0.909,95% CI 0.841-0.977,P < 0.001)and D-dimer(AUC 0.777,95% CI 0.683-0.872,P < 0.001)had higher accuracy in predicting poor prognosis,and their cutoff values were 159.6pg/m and 945ug/L,respectively.The combination of BNP and D-dimer(AUC 0.94% 95% CI 0.889-0.998 P < 0.001)can further improve the accuracy of prediction.Conclusion:1.BNP and D-dimer have certain accuracy in identifying NVAF cerebral embolism,and the combined them can further improve the predictive efficiency.2.BNP and D-dimer have a certain accuracy in predicting the poor prognosis of patients with NVAF cerebral embolism,and the combination can further improve the accuracy of prediction. |
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