Background and Aim

Patients with acute ischemic stroke associated with cancer have D-dimer elevations greater than those with acute ischemic stroke or cancer alone. While D-dimer has been proposed as a screening tool to identify such patients, its use in clinical practice to identify malignancy and to inform the use of CT scanning has not been well characterized.

Methods

We conducted a retrospective cohort study of patients with acute ischemic stroke to evaluate how D-dimer levels and CT chest, abdomen, and pelvis scanning were used in practice to screen for occult malignancy. Patients were excluded if they had known active cancer and or received tPA.

Results

Of 480 patients, 254 (53%) had D-dimer measured, 49 (10%) underwent CT screening for cancer, and 11 (2%) had findings concerning for malignancy. There was no difference in D-dimer level between patients who underwent CT evaluation for cancer and those who did not (median 1.01 vs 0.85 p = 0.19). Patients with CT concerning for cancer had higher D-dimer levels than those with a negative CT (median 2.52 vs 0.74 p = 0.01). D-dimer demonstrated moderate discrimination with a c-statistic of 0.77. Selecting a cut point of >1.2 ug/mL (60^th percentile of our cohort and 2.4-times the upper limit of normal for our institution's D-dimer assay) provided a sensitivity of 85% and specificity of 65%, a positive likelihood ratio of 2.32, and an odds ratio of 9.6 (95% confidence interval 2.1-44.1, p = 0.004) for having a CT scan concerning for malignancy.

Conclusions

Elevated D-dimer levels are suggestive of occult malignancy in acute ischemic stroke patients and should inform selective use of CT to screen for cancer.

中文翻译：

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D-二聚体和身体CT识别急性缺血性卒中的隐匿性恶性肿瘤

背景与目标

与癌症相关的急性缺血性中风的患者的D-二聚体升高高于单独与急性缺血性中风或癌症的患者。虽然已经提出将D-二聚体用作鉴定这类患者的筛选工具，但是其在临床实践中用于鉴定恶性肿瘤和告知CT扫描用途的用途尚未得到很好的表征。

方法

我们对急性缺血性卒中患者进行了一项回顾性队列研究，以评估在实践中如何使用D-二聚体水平以及CT胸部，腹部和骨盆扫描来筛查隐匿性恶性肿瘤。如果患者已知患有活动性癌症或接受过tPA，则排除在外。

结果

在480位患者中，有254位（53％）进行了D-二聚体检测，其中49位（10％）接受了CT筛查以检查癌症，还有11位（2％）进行了有关恶性肿瘤的检查。接受CT评估的癌症患者与未接受CT评估的患者之间的D-二聚体水平无差异（中位数1.01对0.85 p  = 0.19）。与癌症相关的CT患者的D-二聚体水平高于CT阴性的患者（中位数为2.52 vs 0.74 p  = 0.01）。D-二聚体表现出中等偏倚，c统计量为0.77。选择> 1.2 ug / mL（60 ^th我们队列的百分位数和D-二聚体测定法正常上限的2.4倍）提供了85％的敏感性和65％的特异性，2.32的正似然比以及9.6（95％的置信度）间隔2.1-44.1，p  = 0.004）进行有关恶性肿瘤的CT扫描。

结论

D-二聚体水平升高提示急性缺血性中风患者隐匿性恶性肿瘤，应告知选择性使用CT筛查癌症的可能性。