title: Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores on Severity and Functional Outcome in Acute Ischemic Stroke with Atrial Fibrillation.
abstract: BACKGROUND
  We examined the association between pre-admission risk scores and severity on admission and functional outcome in acute ischemic stroke with atrial fibrillation (AF).
  
  
  METHODS
  Between September 2011 and April 2014, we retrospectively extracted consecutive ischemic stroke patients with AF whose pre-admission modified Rankin Scale (mRS) score was 2 or less from our prospective database. Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were calculated in each patient, and their association with the National Institutes of Health Stroke Scale (NIHSS) score on admission or unfavorable outcome (mRS ≥ 3 at 3 months from the onset) was assessed.
  
  
  RESULTS
  A total of 344 patients (189 were men; age, 77.7 ± 10.0 years) were included in the analysis. The median pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were 2, 4, and 4, respectively. NIHSS score on admission was positively correlated with pre-admission CHADS2 (ρ = .116, P = .031), CHA2DS2-VASc (ρ = .166, P = .020), and R2CHADS2 scores (ρ = .106, P = .049). Receiver operating characteristic (ROC) curve analysis revealed that pre-admission CHADS2 score of 2 or more (sensitivity, 80%; specificity, 45%; area under the ROC curve [AUC], .654), CHA2DS2-VASc score of 3 or more (sensitivity, 86%; specificity, 44%; AUC, .683), and R2CHADS2 score of 4 or more (sensitivity, 61%; specificity, 62%; AUC, .657) were associated with unfavorable outcome. The pre-admission CHA2DS2-VASc score was better than the pre-admission CHADS2 score in estimating unfavorable outcome (P = .017). In multivariate analysis, cutoffs of these scores, female sex, higher NIHSS score, and internal carotid artery occlusion were associated with unfavorable outcome.
  
  
  CONCLUSIONS
  Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were associated with onset severity and functional outcome in acute ischemic stroke with AF.
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Torii
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Konosuke
authors.initials: K
authors.lastname: Furuta
authors.affiliation: Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Neurology, Fukuoka City Hospital, Fukuoka, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Yoshimura
authors.affiliation: Department of Neurology, Iizuka Hospital, Iizuka, Japan.
authors.forename: Kei-ichiro
authors.initials: K
authors.lastname: Takase
authors.affiliation: Medical Information Center, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Wakata
authors.affiliation: Medical Information Center, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakashima
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kira
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: hmurai@neuro.med.kyushu-u.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Murai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: Ischemic stroke; atrial fibrillation; outcome; risk score; severity