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.
Clinical neurology Ischaemic stroke Cancer Outcome
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Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest. The authors have nothing to disclose relating to the subject matter of this article.
This work receives no specific funding.
The study was approved by the hospital institutional review board and the ethics committee of the Medical University of Graz.
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