Poor short-term outcome in patients with ischaemic stroke and active cancer

Abstract

Stroke risk is increased in cancer patients and cancer activity has been claimed to play a role in the development of ischaemic stroke (IS). We wanted to further test these assumptions and to explore the impact of such relation on short-term prognosis. We identified all IS patients that were admitted to the neurological department of our primary and tertiary care university hospital between 2008 and 2014 (n = 4918) and reviewed their medical records for an additional diagnosis of cancer. Cancer patients were categorized into those with "active cancer" (AC: recurrent malignant tumour, metastases, ongoing chemo-/radiotherapy) and "non-active cancer" (NAC). We compared demographic, clinical and neuroimaging features of both patient groups and assessed their association with in-hospital mortality. 300 IS patients with known cancer were identified (AC: n = 73; NAC: n = 227). IS patients with AC were significantly younger (70.3 ± 10.6 vs. 74.9 ± 9.9 years), had more severe strokes at admission (NIHSS: median 5 vs. 3), more frequently cryptogenic strokes (50.7 vs. 32.5 %) and more often infarcts in multiple vascular territories of the brain (26 vs. 5.2 %) compared to IS patients with NAC. In-hospital mortality was significantly higher in AC patients (21.9 vs. 6.2 %). Multivariate analysis identified AC (odds ratio [OR] 3.70, 95 % confidence interval [CI] 1.50-9.30), NIHSS at admission (OR 1.10, CI 1.10-1.20) and C-reactive protein level (OR 1.01, CI 1.00-1.02) as factors significantly and independently associated with in-hospital death. Our findings support a direct role of AC in the pathogenesis and prognosis of acute IS. This needs to be considered in the management and counselling of such patients.

Ischemic stroke in cancer patients: A review of an underappreciated pathology

“…13 Furthermore, cancer patients with stroke generally have worse discharge disposition and are more likely to develop early neurological deterioration and in-hospital death than non-cancer patients with stroke. 13, 14 In a case-control study, 32% of cancer patients with ischemic stroke had in-hospital death versus 13% of non-cancer patients with ischemic stroke. 37 Small retrospective studies have reported that high D-dimer levels may be predictive of early neurological deterioration and death in cancer-associated stroke.…”

Comorbidity and the increased mortality after hospitalization for stroke: a population‐based cohort study

“…During 1994–2011, approximately 40% of stroke patients in Denmark had major comorbidities at diagnosis, and this proportion has increased in recent years . Comorbidity affects both short‐ and long‐term mortality after hospital admission for stroke. However, it is unknown whether comorbidity leads to excess post‐stroke mortality, that is mortality beyond that expected from combined individual effects of stroke and comorbidity.…”

Role of Cancer Emboli as a Metastatic Core on the Growth of Brain Metastasis in Patients with Non-Small Cell Lung Cancer

“…It' s a remarkable that the rate of cancer incidence is higher among ischemic stroke patients than the general population 9,13,21,22,25) , and cancer itself may increase a risk of CI occurrence 10,11,16,30) . Once CI occurs in patients with cancer, neurological outcomes significantly worsen, and prognosis tends to be poor in addition to stroke-associated morbidity/mortality 5,15,19) . Among all cancer types, patients with lung cancer have the highest incidence of CI 4) .…”