The improvement of ABCD2 scoring accuracy for predicting cerebral infarction after transient ischemic attack

Abstract

Objective To investigate the application of improved ABCD2 scoring for predicting the onset of cerebral infarction within 7 days after transient ischemic attack (TIA). Methods A total of 133 patients with TIA admitted from July 2014 to December 2015 were enrolled in this study. The ABCD2 scoring and ABCD2 combined with carotid ultrasound (CU) scoring were used to predict the risk of cerebral infarction occurred within 7 days after TIA. The univariate analysis and multivariate logistic regression analysis were performed to estimate the contribution of clinical risk factors to triggering the cerebral infarction within 7 days after TIA. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of two different kinds of scoring process in early cerebral infarction after TIA. Results Of 133 patients with TIA, 35 (26.3%) suffered from cerebral infarction within 7 days after TIA. Univariate analysis showed cerebral infarction occurred within 7days after TIA was closely associated with BP≥140/90 mmHg, unilateral weakness, speech impairment, TIA duration≥10 minutes, past history of hypertension, diabetes mellitus, carotid plaque, and carotid stenosis. Multivariate logistic regression analysis showed that unilateral weakness (OR=3.52, 95%CI: 1.76-12.34), TIA duration≥10 minutes (OR=2.45, 95%CI: 1.06-9.27), diabetes mellitus (OR=3.37, 95%CI: 1.27-10.94), past history of hypertension (OR=4.15, 95%CI: 1.71-13.34), carotid plaque (OR=6.32, 95%CI: 2.46-19.40), and carotid stenosis (OR=12.73, 95%CI: 2.67-44.35) were significantly correlated with early onset of cerebral infarction after TIA (all P<0.05). The ROC analysis revealed the ABCD2-CU scoring (AUC=0.802, 95%CI: 0.717-0.888, P=0.000) had a larger area under curve compared to ABCD2 scoring (AUC=0.614, 95%CI: 0.511-0.717, P=0.036). Conclusions The ABCD2-CU scoring was more accurate in predicting the imminent risk of cerebral infarction in the patients with TIA compared to ABCD2 scoring. And ABCD2 scoring combined with carotid ultrasound could improve the accuracy for predicting the risk of cerebral infarction occurred within 7 days after TIA. Key words: Transient ischemic attack; ABCD2 score; Carotid ultrasound; Cerebral infarction; Prediction