Seeking predictors for paroxysmal atrial fibrillation in stroke with an online clinical database

Abstract

OBJECTIVE: A considerable fraction of ischemic stroke cases remain cryptogenic and there is increasing data suggesting therole of missed paroxysmal atrial fibrillations (pAF) in at least a number of these cases. Since electrophysiological identificationof pAFs can be challenging, there has been an accumulation of proposed predictors and biomarkers for pAFs. The predictivevalues of these is varying and sometimes conflicting among studies. Therefore, we aimed to verify a fraction of previouslyreported parameters for pAF detection by investigating an independent clinical sample.METHODS: Using a publicly available data downloaded from the MIMIC-3 intensive care unit database, we tested the predictive role of particular risk factors and biomarkers for pAF detection after ischemic stroke in 124 patients with ischemic strokeadmitted within 24 hours of stroke onset.RESULTS: Our evaluation revealed a strong association of older age in women, as well as admission National Institutes ofHealth Stroke Scale (NIHSS) and discharge modified Rankin Scores (mRS) in both sexes for pAFs, in patients that were insinus rhythm on admission. We also detected a trend for lower gender-adjusted hemoglobin in patients with pAF, although thedifference was insignificant. On the other hand, we did not find any significant association of pAF detection with some otherpreviously reported biomarkers: serum magnesium level, leukocyte count, neutrophil/lymphocyte ratio or left atrial dilatation.CONCLUSION: Even though our analysis did not reveal a strong and specific biomarker to predict pAFs after stroke, itidentified key risk factors. It may be necessary to consider the possibility of pAFs and perform rigorous evaluation to preventfurther events of embolic stroke in female patients older than 75 years, with more severe neurological deficits on admission,higher disability on discharge and also with relatively lower hemoglobin level. This first study from Turkey using clinical datafrom the MIMIC-3 database also demonstrates the value of publicized clinical data for confirmatory studies on various medicalfields across the World.