Investigation Of Addition Of Fibrinogen To ABCD3-I Score To Predict Early Risk Of Cerebral Infarction After Transient Ischaemic Attack

Objectives:The aim of this study was to investigate the predictive value of ABCD3-I score in combination with the level of fibrinogen(ABCD3-I+ FIB)and ABCD3-I Score along,and their relationships to early risk assessment of cerebral infarction after transient ischaemic attack(TIA).It is hoped to find a better model to evaluate the risk stratification of patients with TIA.For patients with score implying higher risk of cerebral infarction,positive clinical intervention can be administered to reduce the incidence of cerebral infarction events.Methods : Subjects were select form TIA patients enrolled in the Department of Neurology of the First Affiliated Hospital of Bengbu Medical College from October2014 to January 2016.All clinical data were collected and patients were divided into three group-risk stratification: low,medium and high risk groups according to the standard of ABCD3-I score and ABCD3-I+ FIB score.Observation of incidence of cerebral infarction within 2 and 7 days after TIA were recorded.Receiver operating characteristic curve(ROC)and area under the curve(AUC)of each ROC of the two scoring models were calculated.Predictive value of two scoring models for 2 and 7 days cerebral infarction risk after TIA were compared using test Z.Relationship between different risk stratification and incidence rate of early cerebral infarction occurrence after TIA was analyzed based on χ2 test.Multivariate logistic regression analysis was conducted and risk factors were used as independent variables,cerebral infarction occurrence at early time intervals after onset of TIA was used as the dependent variable.The relationship among risk factors and early cerebral infarction occurrence after TIA was analyzed.SPSS version 17.0 was used as the statistical analysis tool,and p < 0.05 represents a statistically significant difference.Results: 1.A total number of 86 patients with TIA were enrolled in the study,including50 males and 36 females.Patient ages range from 23-87 year old and the mean age was63.77±13.17.There were 21 patients with plasma fibrinogen(FIB)level >3.5 g/L(24.42%),with an average level of 3.16 ± 0.96 g/L.Cerebral infarction occurred for 15 subjects within 7 days after TIA,the incidence rate of cerebral infarction was 17.44%,in which 7 cases occurred in 2 days,the incidence rate of cerebral infarction was 8.14%.2.In ABCD3-I and ABCD3-I+FIB predictive models,the AUC and 95% Confidence Intervals for predicting cerebral infarction risk within 2 days after TIA were 0.938(0.873-1.000),0.943(0.874-1.000)respectively.Comparison of the AUC of two scoring models(P> 0.05)reveals no statistically significance between them.3.In ABCD3-I and ABCD3-I+FIB scoring models,the AUC and 95% Confidence Intervals for predicting cerebral infarction risk within 7 days after a TIA were 0.871(0.785-0.957),0.923(0.865-0.982)respectively.Comparison of AUC of two scoring models indicates the largest AUC was ABCD3-I+FIB score with p<0.05.The two scoring models differ in predicting 7-day stroke risk after TIA.4.The difference of the incidence of cerebral infarction was significant among the low,medium and high risk stratification by using ABCD3-I+ FIB scoring model to assess early cerebral infarction risk within 7 days after a TIA(P < 0.05),the difference was statistically significant.5.The multivariate logistic regression analysis showed that the plasma fibrinogen level(> 3.5 g/L),TIA occurrence(> 2 times within 7 days)and DWI hyperintensity were closely related to cerebral infarction at early time intervals after onset of TIA(P < 0.05).Those factors were each independent predictors of cerebral infarction risk after a TIA.Conclusion:The ABCD3-I+ FIB score model has higher value than ABCD3-I score model in predicting early cerebral infarction risk within 7 days after TIA.It may have potential clinical application.