The prognostic value of CHA2 DS2 -VASc and modified-CHADS2 scores for cardiovascular events in diabetics and non-diabetics haemodialysis patients.

Abstract

CHA2 DS2 -VASc and modified-CHADS2 score can easily estimate the risk of stroke in atrial fibrillation. Study's purpose was to evaluate these in haemodialysis patients, and assess the effect of diabetes mellitus (DM). The scores calculated in 237 haemodialysis patients, 121 diabetics (58 females) and 116 non-diabetics (41 females). Results correlated to cardiovascular events (acute myocardial infarction, atrial fibrillation, heart failure, peripheral arterial disease, stroke, mortality). CHA2 DS2 -VASc score correlated with the occurrence of stroke and heart failure (p < .01, p < .01), (p < .01, p < .01), respectively in diabetics and non-diabetics. CHA2 DS2 -VASc score could predict the risk of all-cause mortality in both groups, p = .03, p < .01, respectively, however, the risk of cardiovascular death could be predicted in non-diabetics, p < .01. Modified-CHADS2 score associated with heart failure (p = .04), cardiovascular (p < .01) and all-cause mortality (p < .01) only on non-diabetics. C statistics indicated that the first score showed modest discrimination in patients with and without DM, for stroke and all-cause mortality. The second score performed modestly only on patients without DM for all-cause mortality. Both scores showed poor calibration. Stroke was a common cause of cardiovascular death (OR = 3.52, 95% CI = 1.92-6.47, p < .01) and associated with central venous catheter (OR = 2.19, 95% CI = 1.12-4.27, p = .02) and pre-existing atrial fibrillation (OR = 1.94, 95% CI = 1.06-3.58, p = .03). CHA2 DS2 -VASc score correlated with stroke, heart failure and all-cause mortality in haemodialysis patients with and without DM. The risk of cardiovascular death could be predicted only in non-diabetics patients. Modified-CHADS2 score correlated with heart failure, cardiovascular and all-cause mortality only on non-diabetics. Both had modest discrimination and poor calibration.