title: Early neurological outcomes according to CHADS2 score in stroke patients with non-valvular atrial fibrillation.
abstract: OBJECTIVE
  A higher CHADS(2) score or CHA(2)DS(2)-VASc score is associated with an increased risk of ischaemic stroke in patients with non-valvular atrial fibrillation (NVAF). However, there are no data regarding early neurological outcomes after stroke according to the risk levels.
  
  
  METHODS
  In this study, a total of 649 stroke patients with NVAF were enrolled and categorized into three groups: low-risk (CHADS(2) score of 0-1), moderate-risk (CHADS(2) score 2-3), or high-risk group (CHADS(2) score ≥4). CHA(2)DS(2)-VASc score was divided into four groups including 0-1, 2-3, 4-5, and ≥6. We investigated whether there were differences in initial stroke severity, early neurological outcome, and infarct size according to CHADS(2) score or CHA(2)DS(2)-VASc score in stroke patients with NVAF.
  
  
  RESULTS
  The initial National Institutes of Health Stroke Scale (NIHSS) score was highest in high-risk group [9.5, interquartile range (IQR) 4-18], followed by moderate-risk (8, IQR 2-17) and low-risk group (6, IQR 2-15) (P=0.012). Likewise, initial stroke severity increased in a positive fashion with increasing the CHA(2)DS(2)-VASc score. During hospitalization, those in the high-risk group or higher CHA(2)DS(2)-VASc score had less improvement in their NIHSS score. Furthermore, early neurological deterioration (END) developed more frequently as CHADS(2) score or CHA(2)DS(2)-VASc score increased. Multivariate analysis showed being in the high-risk group was independently associated with END (OR 2.129, 95% CI 1.013-4.477).
  
  
  CONCLUSIONS
  Our data indicate that patients with NVAF and higher CHADS(2) score or CHA(2)DS(2)-VASc score are more likely to develop severe stroke and a worse clinical course is expected in these patients after stroke presentation.
authors.affiliation: Department ofNeurology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Hong
authors.forename: Y D
authors.initials: YD
authors.lastname: Kim
authors.forename: M-J
authors.initials: MJ
authors.lastname: Cha
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.forename: D H
authors.initials: DH
authors.lastname: Lee
authors.forename: H S
authors.initials: HS
authors.lastname: Lee
authors.forename: C M
authors.initials: CM
authors.lastname: Nam
authors.forename: H S
authors.initials: HS
authors.lastname: Nam
authors.forename: J H
authors.initials: JH
authors.lastname: Heo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D016896:Treatment Outcome