Öz
Amaç
CHA₂DS₂-VASc (konjestif kalp yetmezliği, hipertansiyon, ≥75 yaş, diabetes mellitus, inme, vasküler hastalık, 65-74 yaş, kadın cinsiyet) skoru, iskemik inme sonrası kötü sonlanımlarla önemli ölçüde ilişkilidir. Bununla birlikte, lipid parametrelerinin prognoz üzerindeki etkisi net değildir. Bu çalışma, lipid parametrelerinin sonlanımlar üzerindeki ilişkisini araştırmayı ve bunları CHA₂DS₂-VASc skoru ile karşılaştırmayı amaçlamıştır.
Yöntem
2018 ve 2022 yılları arasında başvuran toplam 583 iskemik inme hastası retrospektif olarak analiz edildi. Hastaların demografik verileri, CHA₂DS₂-VASc skorları ve trigliserid/yüksek yoğunluklu lipoprotein (HDL-C) oranı, düşük yoğunluklu lipoprotein (LDL-C)/HDL-C oranı ve aterojenik plazma indeksi (API) gibi lipid parametreleri kaydedildi. Hastalar bir yıl boyunca takip edildi ve tüm nedenlere bağlı ölüm birincil sonlanım noktaları olarak kabul edildi. Mortalitenin öngördürücüleri Cox regresyon analizi ile belirlendi.
Bulgular
Beş yüz seksen üç hastanın ortalama yaşı 71,05±11,83 olup, bir yıllık tüm nedenlere bağlı mortalite oranı %17,3 (n=101) olarak saptandı. Toplam kolesterol, non-HDL-C ve API, kötü sonlanımları olan hastalarda anlamlı derecede daha yüksek bulundu (p=0,003, p=0,031, p=0,019, sırasıyla). Hem API hem de CHA₂DS₂-VASc skoru, güçlü mortalite öngördürcüleri olarak kabul edildi [tehlike oranı (HR): 1,062, %95 güven aralığı (GA): 0,973-1,252, p=0,007] ve (HR: 1.567, %95 GA: 1,003-2,174, p=0,004). Alıcı çalışma eğri analizinde, CHA₂DS₂-VASc skoru API’ya kıyasla daha yüksek öngörü olarak izlendi (eğri altındaki alan: 0,756; p=0,014 vs. 0,568; p=0,045).
Sonuç
CHA₂DS₂-VASc ve API, iskemik inme sonrası bir yıllık mortaliteyi öngörmede değerli prediktörlerdir. Tromboembolizm risk faktörlerini içeren CHA₂DS₂-VASc skoru, kötü sonlanımlar açısından lipid parametrelerine kıyasla daha güçlü duyarlılık ve özgünlüğe sahiptir.
Anahtar Kelimeler: Anahtar kelimeler: Aterojenik plasma indeksi, iskemik inme, kolesterol, lipoprotein
Kaynakça
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