Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke

Ki Woong Nam, Chi Kyung Kim, Tae Jung Kim, Sang Joon An, Kyungmi Oh, Heejung Mo, Min Kyoung Kang, Moon Ku Han, Andrew M. Demchuk, Sang Bae Ko, Byung Woo Yoon

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12 Citations (Scopus)

Abstract

Background Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. Ddimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. Aim In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. Methods We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Results Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46±3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00±1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10±8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. Conclusions D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

Original languageEnglish
Article numbere0172793
JournalPLoS One
Volume12
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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    Nam, K. W., Kim, C. K., Kim, T. J., An, S. J., Oh, K., Mo, H., Kang, M. K., Han, M. K., Demchuk, A. M., Ko, S. B., & Yoon, B. W. (2017). Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke. PLoS One, 12(3), [e0172793]. https://doi.org/10.1371/journal.pone.0172793