R_2(GFR)CHADS₂ and R_2(GFR)CHA₂DS₂VASc schemes improved the performance of CHADS₂ and CHA₂DS₂VASc scores in death risk stratification of Chinese older patients with atrial fibrillation

摘要

Background: This analysis was carried out to refine the CHADS₂ and CHA₂DS₂VASc scores by combining creatinine clearance (CrCl) and glomerular filtration rate (GFR) and evaluate the performance of CrCl-based and GFR-based schemes in death risk stratification of Chinese older patients with atrial fibrillation (AF). Methods: There were 219 older patients with AF, and all-cause mortality was assessed during the follow-up of 1.11?years. Renal function was evaluated using the CrCl formula and different GFR (Modification of Diet in Renal Disease [MDRD], Chinese MDRD [CMDRD], Mayo Clinic Quadratic [Mayo] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) formulas, and five kinds of R₂CHADS₂ and R₂CHA₂DS₂VASc schemes were generated by combining CrCl and GFR with CHADS₂ and CHA₂DS₂VASc scores. Results: In Cox regression multivariate analysis, CrCl 2 was significantly associated with death risk ( P 2 and CHA₂DS₂VASc scores as the linear covariates, CrCl and GFR as the continuous variables were significantly associated with death risk ( P 2(CrCl)CHADS₂ and R_2(CrCl)CHA₂DS₂VASc – moderately exceeded that of CHADS₂ and CHA₂DS₂VASc scores ( P =0.081 and 0.082). C-statistics of GFR-based schemes – R_2(GFR)CHADS₂ and R_2(GFR)CHA₂DS₂VASc – significantly exceeded that of CHADS₂ and CHA₂DS₂VASc scores ( P 2 had a significantly high death risk, and those with lower levels of CrCl or CrCl?2 and CHA₂DS₂VASc scores.