Short-term or long-term outcomes for stroke patients with cancer according to biological markers

Nezu, Tomohisa; Hosomi, Naohisa; Aoki, Shiro; Naito, Hiroyuki; Torii, Tsuyoshi; Kurashige, Takashi; Sugiura, Tomohito; Kuzume, Daisuke; Morimoto, Yuko; Yoshida, Takeshi; Yagita, Yoshiki; Oyama, Naoki; Eto, Futoshi; Shiga, Yuji; Kinoshita, Naoto; Kamimura, Teppei; Ueno, Hiroki; Ohshita, Tomohiko; Makino, Hírofumi

doi:10.1016/j.jns.2022.120246

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…High D-dimer levels were associated with higher mortality and recurrent stroke. 71 Recently, a clinical score for possible cancer was suggested which included five variables (age ⩾ 77, ESUS, multi-territorial infarct, D-dimer levels ⩾ 820 µ/gL, and female sex) to identify patients with occult malignancies. A score of ⩾ 3 predicted an underlying occult malignancy.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing cancer-associated ischemic stroke: A systematic review of hematological biomarkers

Erritzøe-Jervild,

Wenstrup,

Hougaard

et al. 2024

International Journal of Stroke

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Background and aim: Patients suffering from cancer are reported to have an increased risk of ischemic stroke. We aimed to identify cancer-associated biomarkers found to differentiate between ischemic stroke associated with cancer from those not associated with cancer. Summary of review: We performed a systematic search of PubMed and EMBASE databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study is reported in PROSPERO (#CRD42022355129). In total, 5563 papers were screened, of these forty-nine papers were included. Seven biomarkers were identified which had the potential to differentiate between patients who had cancer or stroke or both conditions. D-dimer was the most frequently monitored biomarker, and high levels were significantly associated with cancer-related strokes in (42/44) studies. Fibrinogen was significantly associated with cancer-related strokes in 11/27 studies. A higher level of C-reactive protein, investigated in 19 studies, was associated with cancer-related strokes, but conclusive multivariate analysis was not performed. Finally, the four cancer-associated antigens CA125, CA153, CA199, and carcinoembryonic antigen were only reported on in three to six studies respectively. These studies all originated from the Guangxi province in China. CA125 was associated with an increased risk of ischemic stroke in 4/6 studies. Conclusion: Increased D-dimer seems associated with cancer-related ischemic stroke. CRP may also be a candidate as a cancer-associated stroke biomarker, but this requires further verification. Fibrinogen and the more specific cancer biomarkers have not yet been proven helpful for detecting cancer-related strokes.

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Section: Discussionmentioning

confidence: 99%

Diagnosing cancer-associated ischemic stroke: A systematic review of hematological biomarkers

Erritzøe-Jervild,

Wenstrup,

Hougaard

et al. 2024

International Journal of Stroke

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“…Thus, the early identification and development of novel biomarkers for mortality are urgently required because as the therapy and prognosis of older individuals with AIS depend heavily on the early assessment of mortality risk. Few studies have examined the association between CAR and mortality in patients with AIS; however, none have specifically evaluated the oldest-old individuals, despite some studies evaluating the predictive potential of CAR in diverse diseases [7,[29][30][31]. According to previous investigations, the odds ratios for a greater CAR for mortality risk in the general population varied from 1.08 to 1.78 [30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have examined the association between CAR and mortality in patients with AIS; however, none have specifically evaluated the oldest-old individuals, despite some studies evaluating the predictive potential of CAR in diverse diseases [7,[29][30][31]. According to previous investigations, the odds ratios for a greater CAR for mortality risk in the general population varied from 1.08 to 1.78 [30,31]. The conclusions of earlier research among the oldest-old patients were validated and expanded by our current findings.…”

Section: Discussionmentioning

confidence: 99%

Dose-Response Relationship between C-Reactive Protein/Albumin Ratio and In-Hospital Mortality in Elderly Patients with Acute Ischemic Stroke

Li,

Chen,

Chen

et al. 2023

Gerontology

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Introduction: The C-reactive protein/albumin ratio is a reliable indicator of outcome risk in several diseases. This study aims to evaluate prognostic power of the C-reactive protein/albumin ratio for in-hospital mortality and the dose-response relationship between the two in the oldest-old patients with acute ischemic stroke. Methods: A longitudinal observational study was conducted including patients with acute ischemic stroke (aged ≥ 80 years) from two tertiary hospitals between January 1, 2014, and January 31, 2020. Based on the tertiles of the C-reactive protein/albumin ratio, the patients were divided into three groups. Restrictive cubic spline and robust locally weighted regression analysis were performed on continuous variables to examine the dose–response relationship between the C-reactive protein/albumin ratio and in-hospital mortality risk. All-cause mortality during hospitalization was the outcome for this study. Results: The study included 584 patients (mean age = 84.6 ± 3.1 years; 59.6% men). The C-reactive protein/albumin ratio was divided into three groups, namely, T1 of < 0.73, T2 of 0.73 – 2.03, and T3: > 2.03. After adjusting for demographic and clinical characteristics, a higher C-reactive protein/albumin ratio was independently associated with in-hospital mortality. The hazard ratio for this association was 2.01 (95% confidence interval: 1.12 – 3.60, P = 0.019). A dose–response relationship between the C-reactive protein/albumin ratio and in-hospital mortality risk was observed. Sensitivity analysis found no attenuation in the hazard ratio in uninfected individuals, whereas no difference in the hazard ratio was noted in individuals with infections. Conclusions: When predicting in–hospital mortality in the oldest-old patients with ischemic stroke, the C-reactive protein/albumin ratio might be a helpful and convenient metric.

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“…В данном случае, вероятно, имеет место двунаправленная связь: с одной стороны, соматические заболевания повышают риск развития инсульта и ухудшают его течение, с другой стороны инсульт зачастую приводит к декомпенсации названных расстройств. Наличие дополнительного фактора в виде COVID-19 можно расценивать как фактор, усугубляющий данную взаимосвязь [9].…”

Section: заключениеunclassified

Predictors of In-Hospital Mortality Among Patients with COVID-19 Related Stroke

Rakhmatullin

Kutlubaev

Khairullin³

2023

Annals of Clinical and Experimental Neurology

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Introduction. COVID-19-related stroke is associated with a significantly higher mortality than COVID-19 or stroke alone. Mechanisms underlying the increased mortality of patients with stroke and COVID-19 should be thoroughly studied. Objective: to analyze predictors of hospital mortality associated with COVID-19-related stroke. Materials and methods. We retrospectively analyzed 1,386 cases of COVID-19-related stroke reported by an infectious diseases inpatient clinic in 2020. We studied clinical, laboratory, and instrumental parameters in patients with different outcomes. Logistic regression was used to identify independent predictors of mortality. Results. 539 (38.9%) patients died during their hospital stay, with 437 (38.0%) deaths from ischemic stroke and 102 (42.7%) deaths from hemorrhagic stroke (p = 0.0001). Independent predictors of mortality associated with COVID-19-related stroke included age, neurological deficit severity measured by NIHSS, COVID-19 severity, and laboratory parameters including white blood cell count, creatinine, glucose, and D-dimer blood levels. Discussion. The results of logistic regression analysis were able to explain only 41% of the variability in hospital deaths among patients with stroke associated with COVID-19. Conclusion. Hospital mortality in patients with COVID-19-related stroke is associated with severity of inflammatory response, impaired coagulation, age, neurological deficit severity, and somatic comorbidities.

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Short-term or long-term outcomes for stroke patients with cancer according to biological markers

Cited by 6 publications

References 28 publications

Diagnosing cancer-associated ischemic stroke: A systematic review of hematological biomarkers

Diagnosing cancer-associated ischemic stroke: A systematic review of hematological biomarkers

Dose-Response Relationship between C-Reactive Protein/Albumin Ratio and In-Hospital Mortality in Elderly Patients with Acute Ischemic Stroke

Predictors of In-Hospital Mortality Among Patients with COVID-19 Related Stroke

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