The Relationship Between ATRIA Score and CRP/Albumin in Patients with Non-Valvular Atrial Fibrillation

Yıl 2022, Cilt: 19 Sayı: 3, 570 - 575, 27.12.2022

Serhat Çalışkan , Mehmet Atay , Şenel Altun

https://doi.org/10.35440/hutfd.1127431

Öz

Background: Atrial fibrillation (AF) is the most common arrhythmia in the adult population and causes a significant increase in the risk of thromboembolism. The ATRIA risk scoring system was developed to assess the risk of thromboembolism in AF patients. In our study, we aimed to investigate the relationship between the ATRIA risk score and the C-reactive peptide (CRP)/Albumin ratio in patients with AF.
Materials and Methods: 240 patients with non-valvular AF between December 2015 and December 2021 were included in our study. ATRIA scores were calculated by retrospectively scanning the clinical information and examination results of the patients from the hospital information system.
Results: 240 patients were included in the study. The mean age of the patients was 67.35±9.5, and 42.9% were male. 27.9% of the patients had diabetes mellitus, 44.2% had hypertension, 24.2% had hyperlipidemia and 32.1% had coronary artery disease. According to the ATRIA score, the high-risk group was found to have higher glucose, creatinine, CRP and CRP/Albumin ratios. In the correlation analysis, a positive correlation was found between the ATRIA score and the CRP/Albumin ratio (r=0.687; p=0.001; p<0.01). In multivariate logistic regression analysis, age, CRP, CRP/Albumin ratio, diabetes, and hypertension were found to be independent predictors of the ATRIA score. In Roc analysis, the area under the curve was found to be 0.964 for the platelet lymphocyte ratio (0.941-0.988, p<0.001), the cutoff value for which the CRP/Albumin ratio predicted a high ATRIA score was 0.093 with a sensitivity of 93.8% and a specificity of 93.1%.
Conclusion: CRP and albumin levels are parameters that can be easily measured in the blood. In our study, it was found that the CRP/Albumin ratio correlated with the ATRIA risk score. We believe that the ATRIA risk score can be used in addition to the other scoring systems in the determination of the risky group in terms of thromboembolism in AF patients.

Anahtar Kelimeler

Atrial fibrillation, thromboembolism risk, ATRIA score, CRP/albümin ratio

Non-Valvüler Atriyal Fibrilasyonlu Hastalarda ATRIA Skoru ile CRP/Albumin Arasındaki İlişki

Öz

Amaç: Atriyal fibrilasyon (AF) erişkin popülasyonda en sık görülen aritmi olup tromboemboli riskinde önemli artışa sebep olmaktadır. ATRIA risk skorlaması AF hastalarında tromboemboli riskini değerlendirmek için geliştirilmiştir. Çalışmamızda AF saptanan hastalarda, ATRIA risk skoru ile C-reaktif peptid (CRP)/Albumin oranı arasındaki ilişkiyi incelemeyi amaçladık.
Materyal ve Metod: Çalışmamıza Aralık 2015-Aralık 2021 tarihleri arasında non-valvüler AF’u olan 240 hasta alındı. Hastaların klinik bilgileri ve tetkik sonuçları hastane bilgi sisteminden retrospektif olarak taranarak ATRIA skorları hesaplandı.
Bulgular: Çalışmaya 240 hasta alındı. Hastaların yaş ortalaması 67.35±9.5 olup, %42.9’u erkek idi. Hastaları %27.9’unda diyabetes mellitus, %44.2’sinde hipertansiyon, %24.2’sinde hiperlipidemi, %32.1’inde koroner arter hastalığı mevcuttu. ATRIA skoruna göre yüksek riskli grubun daha yüksek glukoz, kreatinin, CRP ve CRP/Albumin oranına sahip olduğu saptanmıştır. Korelasyon analizinde, ATRIA skoru ve CRP/Albumin oranı arasında pozitif korelasyon tespit edildi (r=0.687; p=0.001; p<0.01). Çok değişkenli lojistik regresyon analizinde, yaş, CRP, CRP/Albumin oranı, diyabet ve hipertansiyonun ATRIA skorunun bağımsız belirleyicileri olarak saptandı. Roc analizinde eğri altında kalan alan trombosit lenfosit oranı için 0.964 (0.941-0.988, p<0.001 ), CRP/Albumin oranının yüksek ATRIA skorunu predikte ettiği kesim değeri %93.8 sensivite, %93.1 spesifite ile 0.093 bulundu.
Sonuç: CRP ve albumin düzeyleri kanda kolaylıkla bakılabilen parametrelerdir. Çalışmamızda CRP/Albumin oranının ATRİA risk skoru ile korelasyon gösterdiği bulundu. AF saptanan hastalarda tromboemboli açısından riskli grubun tayininde skorlama sistemine ek olarak ATRIA risk skorunun da kullanılabileceği kanaatindeyiz.

Anahtar Kelimeler

Atriyal fibrilasyon, tromboemboli riski, ATRIA skoru, CRP/Albumin oranı.

Kaynakça

• 1. Uyarel H, Onat A, Yuksel H, Can G, Ordu S, Dursunoğlu D. Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults. Turk Kardiyol Dern Ars 2008;36(4):214- 222.
• 2. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst Set al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31(19):2369-429.
• 3. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Control and Prevention and the American Heart Association. Circulation 2003; 107: 499-511.
• 4. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108:3006–10.
• 5. Mukamal KJ, Tolstrup JS, Friberg J, Grønbaek M, Jensen G. Fibrinogen and Albumin Levels and Risk of Atrial Fibrillation in Men and Women (the Copenhagen City Heart Study). Am J Cardiol 2006;98(1):75–81.
• 6. Ranzani OT, Zampieri FG, Forte DN, Azevedo LCP, Park M. CReactive Protein/Albumin Ratio Predicts 90-Day Mortality of Septic Patients. Salluh JIF, editor. PLoSOne 2013 ;12;8(3):e59321.
• 7. Massimo ZB, Fabrizio L, Tiziana C, Stefano D. Epidemiology of atrial fibrillation:European perspective. Clin Epidemiol 2014; 6, 213‐220.
• 8. Aspberg S, Chang Y, Atterman A, Bottai M, Go AS, Singer DE. Comparison of the ATRIA, CHADS2, and CHA2DS2-VASc stroke risk scores in predicting ischaemic stroke in a large Swedish cohort of patients with atrial fibrillation. European Heart Journal 2016;37(42):3203–3210.
• 9. Van Den Ham HA, Klungel OH, Singer DE, Leufkens HGM, Van Staa TP. Comparative Performance of ATRIA, CHADS2, and CHA2DS2-VASc Risk Scores Predicting Stroke in Patients With Atrial Fibrillation: Results From a National Primary Care Database. Journals of the American College of Cardiology 2015;66(17):1851–9.
• 10. Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 1997; 96: 1180–1184.
• 11. Pepys MB, Hirschfield GM. C rective protein a critical update. J Clin Invest 2003;111 (12): 1805–12.
• 12. Aviles RJ, Martin DO, Apperson-Hansen C, et al: Inflarnmation as a risk factor for atrial fıbrillation. Circulation 2003; 108: 3006-10.
• 13. Chang CY, Chen JY, Ke D, Hu ML. Plasma levels of lipophilic antioxidant vitamins in acute ischemic stroke patients: correlation to inflammation markers and neurological deficits. Nutrition 2005; 21: 987-93.
• 14. Kuwashiro T, Sugimori H, Ago T, Kuroda J, Kamouchi M, Kitazono T. Predictive role of C reactive protein in stroke recurrence after cardioembolic stroke: the Fukuoka Stroke Registry. BMJ 2013;3(11):1-7.
• 15. Conway DS, Buggins P, Hughes E, Lip GY. Prognostic significance of raised plasma levels of interleukin-6 and C-reactive protein in atrial fibrillation. Am Heart J 2004;148(3):462-6.
• 16. Çağdaş M, Rencüzoğullari İ, Karakoyun S, Karabağ Y, Yesin M, Artaç I, et al. Assessment of Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome. Angiology 2019;70(4): 361-8.
• 17. Şimşek B, Çınar T, Özcan KS, Tanık VO, İnan D, Zeren G, et al. C-Reactive Protein and Albumin Ratio Predicts Mortality in Elderly Patients Aged Eighty Years and Over with Non-St-Segment Elevation Myocardial Infarction. İstanbul Med J 2021; 22(2): 88-93.