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

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• 作者：Markus Kneihsl ; Christian Enzinger ; Gerit Wünsch ; Michael Khalil…
• 关键词：Clinical neurology ; Ischaemic stroke ; Cancer ; Outcome
• 刊名：Journal of Neurology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：263
• 期：1
• 页码：150-156
• 全文大小：707 KB
• 参考文献：1.World health organization. Changing history. World health report 2004, pp 120–125
  2.Zöller B, Ji J, Sundquist J, Sundquist K (2012) Risk of haemorrhagic and ischaemic stroke in patients with cancer: a nationwide follow-up study from Sweden. Eur J Cancer 48:1875–1883CrossRef PubMed
  3.Grisold W, Oberndorfer S, Struhal W (2009) Stroke and cancer: a review. Acta Neurol Scand 119:1–16CrossRef PubMed
  4.Cestari DM, Weine DM, Panageas KS, Segal AZ, DeAngelis LM (2004) Stroke in patients with cancer: incidence and aetiology. Neurology 64:2025–2030CrossRef
  5.Zhang YY, Cordato D, Shen Q, Sheng AZ, Hung WT, Chan DK (2007) Risk factor, pattern, etiology and outcome in ischemic stroke patients with cancer: a nested case-control study. Cerebrovasc Dis 23:181–187CrossRef PubMed
  6.Kim K, Lee JH (2014) Risk factors and biomarkers of ischemic stroke in cancer patients. J Stroke 16:91–96PubMedCentral CrossRef PubMed
  7.Schwarzbach CJ, Schaefer A, Ebert A et al (2012) Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke 43:3029–3034CrossRef PubMed
  8.Karlińska AG, Gromadzka G, Karliński MA, Członkowska A (2015) The activity of malignancy may determine stroke pattern in cancer patients. J Stroke Cerebrovasc Dis 24(2):348–353CrossRef
  9.Kim SG, Hong JM, Kim HY et al (2010) Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in Korea. Stroke 41:798–801CrossRef PubMed
  10.Navi BB, Singer S, Merkler AE et al (2014) Cryptogenic subtype predicts reduced survival among cancer patients with ischemic stroke. Stroke 45:2292–2297PubMedCentral CrossRef PubMed
  11.Lee EJ, Nah HW, Kwon JY, Kang DW, Kwon SU, Kim JS (2014) Ischemic stroke in patients with cancer: is it different from usual stroke. Int J Stroke 9:406–412CrossRef PubMed
  12.Aarnio K, Joensuu H, Haapaniemi E et al (2015) Cancer in young adults with ischemic stroke. Stroke 46:1601–1606. doi:10.​1161/​STROKEAHA.​115.​008694 CrossRef PubMed
  13.Lee AY, Levine MN, Prins M et al (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349(2):146–153CrossRef PubMed
  14.Goldstein L, Samsa G (1997) Reliability of the national institutes of health stroke scale. Stroke 28:307–310CrossRef PubMed
  15.Adams HP, Bendixen BH, Kappelle LJ et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 24:35–41CrossRef PubMed
  16.Rolfs A, Fazekas F, Grittner U et al (2013) Acute cerebrovascular disease in the young: the stroke in young fabry patients study. Stroke 44(2):340–349CrossRef PubMed
  17.Rodriguez-Yanez M, Castillo J (2008) Role of inflammatory markers in brain ischemia. Curr Opin Neurol 21:353–357CrossRef PubMed
  18.Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420:860–867PubMedCentral CrossRef PubMed
  19.Navi BB, Reiner AS, Kamel H et al (2015) Association between incident cancer and subsequent stroke. Ann Neurol 77(2):291–300CrossRef PubMed
  20.Iodice S, Gandini S, Löhr M, Lowenfels AB, Maisonneuve P (2008) Venous thromboembolic events and organ-specific occult cancers: a review and meta-analysis. J Thromb Haemost 6(5):781–788CrossRef PubMed
  21.Wahrenbrock M, Borsig L, Le D, Varki N, Varki A (2003) Selectin-mucin interactions as a probable molecular explanation for the association of Trousseau syndrome with mucinous adenocarcinomas. J Clin Investig 112(6):853–862PubMedCentral CrossRef PubMed
  22.Kang DW, Chalela JA, Ezzeddine MA, Warach S (2003) Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes. Arch Neurol 60:1730–1734CrossRef PubMed
  23.Edoute Y, Haim N, Rinkevich D, Brenner B, Reisner SA (1997) Cardiac valvular vegetations in cancer patients: a prospective echocardiographic study of 200 patients. Am J Med 102(3):252–258CrossRef PubMed
  24.Gattringer T, Ferrari J, Knoflach M et al (2014) Sex-related differences of acute stroke unit care: results from the Austrian stroke unit registry. Stroke 45(6):1632–1638CrossRef PubMed
  
• 作者单位：Markus Kneihsl (1)
  Christian Enzinger (1) (2)
  Gerit Wünsch (3)
  Michael Khalil (1)
  Valeriu Culea (1)
  Tadeja Urbanic-Purkart (1)
  Franz Payer (1)
  Kurt Niederkorn (1)
  Franz Fazekas (1)
  Thomas Gattringer (1)
  
  1. Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
  2. Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
  3. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Neurology
  Neurosciences
  Neuroradiology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1459

文摘

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.