| Objective:By comparing the relevant demographic,imaging and laboratory indicators of patients with mild ischemic stroke(MIS)combined with atrial fibrillation,to explore the independent risk factors that affect the short-term poor prognosis of those patients,meanwhile compared the relation between the incidence of end-point events and different starting anticoagulation time in people.Methods:A retrospective analysis of 128 patients with mild acute ischemic stroke and atrial fibrillation admitted to the neurology ward of the First Affiliated Hospital of Nanchang University from December 2019 to December 2020(NIHSS score 0-5).According to the short-term prognosis after the onset,it was divided into a poor prognosis group(mRS score of 3-6 points at 90 days)and a good prognosis group(mRS score of 0-2 points at 90 days).And compared the demographic data,laboratory tests,Imaging data,complications(such as bleeding events during treatment,pulmonary infection,etc.),recurrent stroke events,and all-cause death within 90 days after the onset of onset between the two groups,to evaluate independent risk factors for poor prognosis.At the same time,according to the different initiation time of anticoagulation therapy,it is divided into nonanticoagulation group(anticoagulation therapy is not initiated during hospitalization),early anticoagulation group(anticoagulation therapy is initiated within 3 days after the onset of the disease),and delayed anticoagulation group(anticoagulation therapy is initiated within 4-14 days after the onset of the disease),compare the incidence of end-point events(90-day adverse prognosis,bleeding event rate,all-cause mortality,stroke recurrence rate)between these groups,to evaluate the anticoagulation initiation time whether has an impact on the patient’s end-point event occurrence.Results:A total of 128 patients with mild acute ischemic stroke and atrial fibrillation were collected,of which 99 were in the good prognosis group and 29 were in the poor prognosis group.Through univariate analysis,the results showed that the poor prognosis group’s age and previous medical history(history of hypertension,history of diabetes,Stroke history),neutrophil to lymphocyte ratio(NLR),fasting blood glucose,glycosylated hemoglobin,albumin,incidence of lung infection,cerebral infarction area,NIHSS score at admission,mRS score at admission,CHADS2 VASc score,incidence of bleeding events,and brain infarct recurrence rate was statistically different from the good prognosis group(P<0.05).And through binary logistics regression analysis,high NLR(OR = 0.778,P <0.05),high glycosylated hemoglobin(OR = 0.358,P <0.05),low albumin(OR = 0.659,P <0.05),bleeding events(OR=0.112,P<0.05)and recurrence of cerebral infarction(OR=0.020,P<0.05)are independent risk factors for poor prognosis.The accuracy of these factors were 0.632,0.716,and 0.725 respectively(cutoff values were 4.028,6.05,and 38.25,respectively).In additiorespectivelyn,the AUC of albumin combined with glycosylated hemoglobin and NLR is higher than the AUC of a single factor(NLR +glycosylated hemoglobin: 72.2%;NLR + albumin: 79.1%;glycosylated hemoglobin+ albumin: 82.0%;albumin + NLR + glycosylated hemoglobin: 86.5%).At the same time,this study showed that there was no statistically significant difference between the initial anticoagulation time and the end-point event rate in those patients(P>0.05).Conclusions:The independent risk factors for poor prognosis of patients of mild acute ischemic stroke with arial fibrillation are high NLR,high glycosylated hemoglobin,low serum albumin,bleeding events and stroke recurrence events.Due to the small sample size,the end-point event rate is low,and it is impossible to prove that there is a statistical difference between the initiation of anticoagulation time and the end-point event rate. |
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