Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Purpose The aim of the study was to investigate factors which may predispose patients to early neurological deterioration (END) and explore peripheral biomarkers for the prediction of END in cardiogenic cerebral embolism (CCE) patients. Methods Patients diagnosed with CCE within 24 hr of onset between January 2017 and January 2019 were included in this study. END was defined as an increase of ≥2 on the National Institutes of Health Stroke Scale (NIHSS) or the emergence of new neurological symptoms within 3 days of admission. Binary logistic regression was used to investigate the factors associated with END. Receiver operating characteristic (ROC) curves were then generated to determine the predictive value of the potential biomarkers and the optimal cutoff values. Results Of the 129 (male, 55.81%; mean age 71.85 ± 11.99 years) CCE patients, 55 patients with END were identified. Hemorrhage transformation (HT), coronary heart disease (CHD), diastolic blood pressure, cystatin C levels, NIHSS score, and platelet‐to‐lymphocyte ratio (PLR) at admission were independently associated with END. A peripheral cystatin C level ≥ 1.41 mg/L and a PLR ≥ 132.97 were predictive factors for END in CCE patients. The lymphocyte‐to‐monocyte ratio (LMR) was negatively independently associated with HT, and LMR
Early neurological deterioration (END) in the early phase of acute ischemic stroke (AIS) generally leads to a marked increase in poor prognosis due to diverse mechanisms. Cystatin C levels (cutoff value 1.41 mg/L, AUC 0.635, 95% CI 0.537–0.733, p = .009) and PLR (cutoff value 132.97, AUC 0.619, 95% CI 0.518–0.719, p = .02) were predictive of END, with high specificity and sensitivity. Hemorrhage transformation (HT) was independently associated with END, the lymphocyte‐to‐monocyte ratio (LMR) was negatively independently associated with HT, and LMR