Faysal ŞAYLIK, Murat SELÇUK, Mustafa ETLİ

Kapağa Bağlı Olmayan Atriyal Fibrilasyonlu Hastalarda Trombosit/Lenfosit Oranı ile CHA2DS2-VASc Skoru Arasındaki İlişki

Giriş: Atriyal fibrilasyonlu hastalarda tromboemboli riskini belirlemede en yaygın kullanılan skorlama sistemi CHA2DS2-VASc skorudur. Trombosit/lenfosit oranı (TLO) özellikle kanser hastalarında tanımlanan inflamasyonun önemli bir belirtecidir. Bizim bu çalışmamızın amacı kapağa bağlı olmayan atriyal fibrilasyonlu (KBOAF) hastalarda, TLO ile CHA2DS2-VASc skoru arasındaki ilişkiyi araştırmaktır. Hastalar ve Yöntem: Bu retrospektif çalışmada, kliniğimize 2010 ve 2016 yılları arasında başvuran 184 kapağa bağlı olmayan atriyal fibrilasyonlu hastanın (ortalama yaş 68 ± 11.4 ve % 51.6 erkek) medikal kayıtları retrospektif olarak tarandı. Bulgular: CHA2DS2-VASc skoruna göre yüksek riskli grubun düşük-orta olan gruba oranla daha yüksek TLO, daha düşük sol ventrikül ejeksiyon fraksiyonu (SVEF) ve daha düşük beyaz küre sayısı (BK)’na sahip olduğu saptanmıştır. İstatistiksel önemi düşük olsa da glomerüler filtrasyon hızı (GFH), yüksek risk grubunda daha düşük saptanmıştır. Korelasyon analizinde, CHA2DS2-VASc skoru TLO ile orta pozitif korelasyon (r= 0.3, p< 0.01), SVEF ile orta negatif korelasyon (r= -0.383, p< 0.01), GFH (r= 0.235, p= 0.01) ve BK (r= 0.235, p= 0.01) ile zayıf negatif korelasyona sahip olduğu görüldü. Çok değişkenli lojistik regresyon analizinde, trombosit/lenfosit oranı ve SVEF CHA2DS2-VASc skorunun bağımsız belirleyicileri oldukları saptandı. Roc analizinde eğri altında kalan alan TLO için 0.61 (0.53-0.7, p< 0.05) ve SVEF için 0.69 (0.61-0.77, p< 0.001) olarak saptanmıştır. TLO için %65 duyarlılık ve %61 özgüllük ile yüksek CHA2DS2-VASc skorunu saptamada eşik değer 112.5 olarak tespit edildi. Sonuç: KBOAF’li hastalarda TLO’nun yüksek CHA2DS2-VASc skoruyla korelasyon gösterdiği ve bu hasta grubunda tromboemboli açısından yüksek riski belirlemede skorlama sistemine ek ve yardımcı bir parametre olarak kullanılabileceğini ortaya koyduk.

Anahtar Kelimeler:

Atriyal fibrilasyon, trombosit/lenfosit oranı, CHA2DS2-VASc skoru, tromboemboli riski

Association Between Platelet/Lymphocyte Ratio and CHA2DS2-VASc Score in Patients with Nonvalvular Atrial Fibrillation

Introduction: The most commonly used scoring system in determining the risk of thromboembolism in atrial fibrillation (AF) patients is CHA2DS2-VASc score. Platelet/lymphocyte ratio (PLR) is recently reported as an important indicator of inflammation especially in patients with malignancy. In this study, our aim was to investigate the association between PLR and CHA2DS2-VASc scores in patients with nonvalvular AF. Patients and Methods: In this retrospective study, medical records of 184 patients (Mean age 6 8 ± 11.4 years and 51.6% men) admitted to our clinic with nonvalvular AF between the years 2010 and 2016 were examined. Results: Patients with high risk of stroke according to CHA2DS2-VASc score had greater PLR, less left ventricular ejection fraction (LVEF), and less white blood cell counts compared to those of low and moderate risk groups combined. Glomerular filtration rate (GFR) values were also found lower in high risk group, albeit with a borderline statistical significance. In correlation analysis, CHA2DS2-VASc score demonstrated moderate positive correlation with PLR (r= 0.3, p< 0.01), moderate negative correlation with LVEF (r= -0.383, p< 0.01), and a weak negative correlation with GFR (r= -0.235, p= 0.01) and WBC (r= -0.235, p= 0.01). In multivariate logistic regression analysis, PLR and LVEF were shown to be independent predictors of CHA2DS2-VASc score. Area under the curve (AUC) was 0.61 (0.53-0.7, p< 0.05) for PLR and 0.69 (0.61-0.77, p< 0.001) for LVEF. The PLR value 112.5 predicted high CHA2DS2-VASc scores with a sensitivity of 65% and specifity of 61%. Conclusion: Our findings suggest PLR as a predictor of CHA2DS2-VASc scores in patients with nonvalvular AF.

Keywords:

Atrial fibrillation, platelet to lymphocyte ratio, CHA2DS2-VASc score, thromboembolism risk,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi