The Investigate Into The Value Of STAF And LADS Scores Combined With Serum D Dimer Level For Screening Patients With Atrial Fibrillation Associated Stroke

BackgroundCardiac cerebral embolism(CCE)is one of the subtypes of ischemic cerebral stroke.Compared with other types of ischemic stroke,its clinical harm is often more severe,often compared with higher death rate,disability and the recurrence rate.Atrial fibrillation is one of the main potential causes of CCE and is an independent risk factor.The secondary prevention program of CCE is completely different from that of arterial embolization,so it is very important to timely identify CCE,especially for patients with unexplained stroke,and to carry out early and effective secondary prevention.But at the present,compared with other countries,such as Europe and the United States,there is a significant missed diagnosis rate of stroke complicated with atrial fibrillation in China.Recent researches suggested STAF Score(the Score for the Targeting of Atrial Fibrillation),LADS Score can be used for preliminary screening for ischemic stroke complicated with atrial fibrillation,but the effectiveness of the two scales is still controversial,still needs further validation.As an indicator of hypercoagulability and secondary hyperfibrinolysis in vivo,serum D dimer level is associated with ischemic stroke complicated with atrial fibrillation.At present,there is no study on the screening value of the two scales combined with D dimer level for ischemic stroke complicated with atrial fibrillation.Of this study was to explore the screening values of STAF score≥ 5 points,LADS score ≥ 4 points and D dimer level for ischemic stroke complicated by atrial fibrillation and best threshold value of D dimer level,at the same time to evaluate the value of screening of two scores combined with D dimer level,in order to offer reference for clinical screening of ischemic stroke complicated by atrial fibrillation.ObjectivesTo investigate the screening value of STAF score and LADS score,serum D dimer level in patients with ischemic stroke complicated with atrial fibrillation,and the screening value of the two scales combined with D dimer level respectively.MethodsFrom July 1,2013 to July 1,2019,1767 patients with ischemic stroke were enrolled in this retrospective study from the department of Neurology of Zhong Da Hospital Affiliated of Southeast University and of Xi Shan Hospital of city Wu Xi,of which 356 patients were diagnosed with transient ischemic attack(TIA).According to the classification of Toast(Trial of ORG 10172 in Acute Stroke Treatment),patients with cardiogenic embolization who were clearly diagnosed as atrial fibrillation were classified as atrial fibrillation associated stroke group.Major atherosclerotic tupe,arteriolar occlusive type and other clearly caused type of stroke were classified as nonfibrillation related stroke group.In the fibrillation associated stroke group,430 patients completed the LADS score and 325 patients completed the STAF score.There were1270 cases in the non-fibrillation related stroke group: among them,1270 cases completed the LADS score and 1019 cases completed the STAF score.The clinical data of the two groups were compared,and the screening model of ischemic stroke complicated with atrial fibrillation score was used: STAF score and LADS score were used to score the clinical and auxiliary examination data of the patients.ROC curve was used to evaluate the screening value of STAF score,LADS score model,D dimer level and combination in the screening of ischemic stroke with atrial fibrillation,and the optimal threshold value of D dimer for the screening of ischemic stroke with atrial fibrillation was determined.Then the two scales were tested in parallel with D dimer.ResultsThe age and baseline NHISS score of patients in the atrial fibrillation related stroke group were significantly higher than those in the non-atrial fibrillation related stroke group,and the differences were statistically significant(all P <0.0001).However,there was no statistical difference in the smoking history and other clinical data between the two groups(all P >0.05).Logistic regression analysis showed that baseline NHISS score was an independent risk factor for ischemic stroke associated with atrial fibrillation(P <0.0001,OR=0.062).Logistic regression analysis showed that STAF score ≥5(P =0.024,OR=5.512),LADS score(P <0.0001,OR=0.992),and serum D dimer level(P <0.0001,OR=0.402)all had effects on ischemic stroke complicated with atrial fibrillation.The sensitivity and specificity of STAF≥5 points in screening patients with ischemic stroke complicated with atrial fibrillation were 87.4% and 75.7%respectively.The sensitivity and specificity of LADS≥4 points in screening for ischemic stroke complicated with atrial fibrillation were 38.4% and 84.3% respectively.The optimal threshold value of D dimer screening for ischemic stroke with atrial fibrillation was 739.0 ng/ml,with a sensitivity of 60.0% and specificity of 90.3%.The combination of STAF score and D dimer level showed a sensitivity of 95.0% and a specificity of 68.4% and the LADS score showed a sensitivity of 84.5% and a specificity of 76.1% when combined with D dimer.Conclusion(1)STAF≥5 points and LADS≥4 points both have certain values in screening stroke complicated with atrial fibrillation,but the LADS score alone has limited value in screening.(2)The two screening scores of ischemic stroke complicated with atrial fibrillation have their respective advantages: the ROC AUC and sensitivity of STAF score are higher than that of LADS score,this means in clinical application STAF score can reduce the rate of missed diagnosis,and the specificity of STAF score is lower than that of LADS score,that is,the misdiagnosis rate of STAF score will be higher than that of LADS score.(3)The negative prediction rate of STAF score ≥5 points is high,up to 94.9%,indicating that 94.9% of stroke patients with STAF score <5 points were not patients with atrial fibrillation.(4)The application of D dimer in the primary screening of ischemic stroke complicated with atrial fibrillation has certain screening value.(5)The two scoring systems combined with D dimer can improve the screening value of atrial fibrillation complicated with ischemic stroke.