Validation And Refinement Of The ABCD2 Score To Predict Cerebral Infarction Risk After Transient Ischemic Attack

Objective To validate the ABCD2 score and explore the ability of ABCD2F(ABCD2+Fib) score in predicting cerebral infarction of transient ischemic attack (TIA) patients at 7th day.Methods The age , sex, blood pressure , clinical features , diabetes ,hypertension and fibrinogen were collected in a cohort of hospitalized 135 TIA patients. The California,ABCD,ABCD2 and ABCD2 F scores were applied to all the patients and used to observe the 7-day cerebral infarction risk. We analysised the relationship between clinical data and cerebral infarction risk. A 8-point scoring system was described for stratifying risk after TIA. This score incorporates age(A),blood Pressure(B),clinical features(C),duration (D), diabetes (D) and fibrinogen(F)of TIA patiens(age≥60years [1 point]; blood pressure≥140/90 mmHg [1]; clinical features: unilateral weakness [2], speech impairment without weakness[1]; duration≥60 minutes [2] or 10 to 59 minutes [1]; diabetes [1] and fibrinogen≥3.5g/L [1]). The TIA patients were classified as high risk (score 6 to 8), moderate risk (score 4 to5), and low risk (score 0 to 3).Results The AUCs(95%CI) of the ABCD2 F, ABCD2, ABCD and California scores are 0.755(0.668-0.842),0.711(0.618-0.804),0.658(0.562-0.754), 0.534(0.428-0.639) respective.13 TIA patients scored 2 or less ,and the occurrence of cerebral infarction is 0 ; 12 patients scored 3, and the occurrence is 8%; 30 patients scored 4, and the occurrence is 17%; 40 patients scored 5 , and the occurrence is 25%; 28 patients scored 6 , and the occurrence is 54%; 12 TIA patients scored 7 or more , and the occurrence is 58%. The 7-day risk of stroke was 4% in patients with an ABCD2F score of low risk(0-3),21% with a score of moderate risk(4 -5),and, 55% with a score of high risk(6-8) (P < 0.05).Duration≥10 minutes,focal weakness ,diabetes mellitus ,hypertension, blood pressure on initial evaluation≥140/90mmHg and fibrinogen≥3.5g/L were the independent predictor of 7 - day risk of cerebral infarction respective.Conclusions The ABCD2 score is effective to predict short- term risk of cerebral infarction in the patients with TIA. Combination with fibrinogen can improve the predictive accuracy of 7- day risk of cerebral infarction after TIA.