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.

中文翻译：

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癌症患者缺血性卒中后6个月内死亡的危险因素

目标

当预期生存期≥6个月时，建议对急性缺血性中风的癌症患者进行静脉内重组组织纤溶酶原激活剂（rt-PA）治疗，但尚不清楚中风后6个月内死亡和中风复发的危险因素。因此，我们旨在确定癌症患者中风后六个月内死亡和复发风险的标志物。

材料和方法

在一项回顾性队列研究中，受试者包括2008年至2019年在圣玛丽安娜大学医院住院的急性缺血性中风并患有癌症的患者。为了评估初始中风后24小时内的临床因素与6天内死亡或中风复发事件之间的关联脑卒中发作后的第三个月分别使用Logistic分析和Cox比例风险回归分析。接下来，使用接收器操作特征曲线分析确定了不同死亡率组的最佳标记截止点，并使用Kaplan-Meier方法比较了每组的累积结局发生率。

结果

在194名发展为中风的癌症患者中，最终选择了167名进行分析。中风发作后6个月内有47名受试者（28.14％）死亡，而20名受试者（11.98％）出现了中风复发。D-二聚体水平高，纤维蛋白原水平低，格拉斯哥预后评分高（GPS）和多处血管区域梗死与死亡独立相关，其中D-二聚体水平≥3.95mg / dl的组中死亡率较高，纤维蛋白原水平<277.5 mg / dl，GPS评分为2。纤维蛋白原水平低，缺乏抗栓治疗和转移灶与中风复发相关。

结论

当患有癌症的患者罹患中风时，D-二聚体水平，纤维蛋白原水平，GPS和多个血管区域梗塞将与6个月内死亡的风险相关。纤维蛋白原水平低，缺乏抗血栓治疗和转移的存在与中风复发的高风险相关。