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The Risk Factors for Death within 6 Months After Ischemic Stroke in Patients with Cancer

      Abstract

      Objectives

      While the intravenous recombinant tissue plasminogen activator (rt-PA) therapy for acute ischemic stroke patients with cancer is recommended when survival of ≥ 6 months is expected, the risk factors for death and stroke recurrence within 6 months after stroke are not well known. Thus, we aimed to identify markers for death and recurrence risks within six months from stroke onset in patients with cancer.

      Materials and Methods

      In a retrospective cohort study, the subjects comprised acute ischemic stroke patients with cancer hospitalized at St. Marianna University hospital from 2008 through 2019. To evaluate the associations between the clinical factors within 24 h of the initial stroke and death or stroke recurrence events within 6 months from stroke onset, Logistic analysis and Cox proportional hazards regression analysis was used respectively. Next, the optimal cutoff point of markers for different mortality groups was determined using the receiver operating characteristic curve analysis and cumulative outcome rate of each group was compared using the Kaplan–Meier method.

      Results

      Among 194 patients with cancer who developed acute stroke, 167 were ultimately selected for analysis. 47 subjects (28.14%) passed away within 6 months following stroke onset, and 20 subjects (11.98%) had stroke recurrence. High D-dimer levels, low fibrinogen levels, high Glasgow prognostic scores (GPS), and multiple vascular territory infarctions was independently associated with death, where higher death rate was significantly confirmed in the group with D-dimer levels of ≥3.95 mg/dl, fibrinogen levels <277.5 mg/dl and GPS scores of 2. Low fibrinogen level, lack of antithrombotic therapy, and the presence of metastasis were associated with stroke recurrence.

      Conclusions

      When patients with cancer suffer stroke, D-dimer levels, fibrinogen levels, GPS, and multiple vascular territory infarctions would be associated with the risk of death within 6 months. Low fibrinogen levels, lack of antithrombotic therapy, and the presence of metastasis correlated with high risk of stroke recurrence.

      Key Words

      Abbreviations:

      rt-PA (recombinant tissue plasminogen activator), GPS (Glasgow prognostic scores), QOL (quality of life), DVT (deep vein thrombosis), NIHSS (National Institutes of Health Stroke Scale), HT (hypertension), DL (dyslipidemia), DM (diabetes mellitus), CKD (chronic kidney disease), AF (atrial fibrillation), HbA1c (hemoglobin A1c), eGFR (estimated glomerular filtration rate), TOAST (the trial of ORG 10172 in acute stroke treatment), WBC (white blood cell count), Hb (hemoglobin level), Plt (platelet count), TP (total protein), Alb (albumin), Cr (creatinine), CRP (C-reactive protein), PT/INR (prothrombin time/international normalized ratio), APTT (activated partial thromboplastin time), SPSS (statistical package for the social sciences), ROC (the receiver operating characteristic), NBTE (nonbacterial thrombotic endocarditis), AUC (The area under the curve), DIC (disseminated intravascular coagulation), mRS (modified Rankin scale)
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