Cancer is associated with inferior outcome in patients with ischemic stroke
Background Whether patients with stroke and cancer exhibit specific characteristics has remained controversial. Methods Medical records of patients with ischemic stroke in 2014 or 2015 registered in the Swiss Stroke Registry of Zurich were retrospectively analyzed and integrated with regional cancer...
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| Veröffentlicht in: | Journal of neurology 2021-11, Vol.268 (11), p.4190-4202 |
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| creator | Seystahl, Katharina Hug, Alessia Weber, Sung Ju Kapitza, Sandra Gramatzki, Dorothee Wanner, Miriam Katan, Mira Luft, Andreas R. Rohrmann, Sabine Wegener, Susanne Weller, Michael |
| description | Background
Whether patients with stroke and cancer exhibit specific characteristics has remained controversial.
Methods
Medical records of patients with ischemic stroke in 2014 or 2015 registered in the Swiss Stroke Registry of Zurich were retrospectively analyzed and integrated with regional cancer registry data. Associations of clinical and outcome parameters with cancer diagnosed up to 5 years prior to stroke were tested.
Results
Of 753 patients with ischemic stroke, 59 patients with cancer were identified. History of venous thromboembolism (
p
|
| doi_str_mv | 10.1007/s00415-021-10528-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8505392</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2580827954</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-2f137aeec7a90175335275436c815ed9fed210c3e7965c638777ff7bb3b8f7193</originalsourceid><addsrcrecordid>eNp9kUFvEzEQhS0EomnaP8ChWolLLwtjjx3bl0ooKgVRiQucLceZbVyy69TeLeLfY5pQCgdOluZ98_xGj7FXHN5wAP22AEiuWhC85aCEafEZm3GJouVS2edsBiihVajkETsu5RYATBVesiNEK1XdnrFPSz8Eyk0sjS8lhehHWjff47hp4tBRjik3aRpD6qkOmp0fIw1jORAlbKiPoSljTt_ohL3o_LbQ6eGds6_vL78sP7TXn68-Lt9dt0FqObai46g9UdDeAtcKUQmtJC6C4YrWtqO14BCQtF2osECjte46vVrhynSaW5yzi73vblr1tA41UPZbt8ux9_mHSz66v5UhbtxNundGgUIrqsH5wSCnu4nK6Pp6Cm23fqA0FSeUEGgs1FBz9vof9DZNeajnVcqAEdo-UGJPhZxKydQ9huHgfnXl9l252pV76MphXTp7esbjyu9yKoB7oFRpuKH85-__2P4EYQ6fUw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2580827954</pqid></control><display><type>article</type><title>Cancer is associated with inferior outcome in patients with ischemic stroke</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Seystahl, Katharina ; Hug, Alessia ; Weber, Sung Ju ; Kapitza, Sandra ; Gramatzki, Dorothee ; Wanner, Miriam ; Katan, Mira ; Luft, Andreas R. ; Rohrmann, Sabine ; Wegener, Susanne ; Weller, Michael</creator><creatorcontrib>Seystahl, Katharina ; Hug, Alessia ; Weber, Sung Ju ; Kapitza, Sandra ; Gramatzki, Dorothee ; Wanner, Miriam ; Katan, Mira ; Luft, Andreas R. ; Rohrmann, Sabine ; Wegener, Susanne ; Weller, Michael</creatorcontrib><description>Background
Whether patients with stroke and cancer exhibit specific characteristics has remained controversial.
Methods
Medical records of patients with ischemic stroke in 2014 or 2015 registered in the Swiss Stroke Registry of Zurich were retrospectively analyzed and integrated with regional cancer registry data. Associations of clinical and outcome parameters with cancer diagnosed up to 5 years prior to stroke were tested.
Results
Of 753 patients with ischemic stroke, 59 patients with cancer were identified. History of venous thromboembolism (
p
< 0.001) was associated with cancer while age and cardiovascular risk factors were not. Higher levels of D-dimers (
p
= 0.001), erythrocyte sedimentation rate (
p
= 0.003), C-reactive protein (CRP) (
p
< 0.001), and lower levels of hemoglobin (
p
= 0.003) were associated with cancer. For platelets, pathologically low (
p
= 0.034) or high levels (
p
< 0.001) were linked to cancer. Modified Rankin scale (mRS) scores ≥ 4 on admission and at follow-up were more frequent in cancer patients (
p
= 0.038 and
p
= 0.001). Poor post-stroke survival was associated with cancer (HR 2.2,
p
< 0.001). Multivariable analysis identified venous thromboembolism (OR 5.1), pathologic platelet count (OR = 2.9), low hemoglobin (OR 2.5) and elevated CRP (OR 1.8) as independently associated with cancer. In multivariable Cox regression, risk for death was associated with cancer (HR 1.7), low hemoglobin (HR 2.6), mRS on admission ≥ 4 (HR 1.9), pathologic platelet count (HR 1.6), female sex (HR 1.7), and elevated CRP (HR 1.4).
Conclusions
Considering cancer as a cofactor for post-stroke outcome may impact clinical decision making.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/s00415-021-10528-3</identifier><identifier>PMID: 33945004</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Brain Ischemia - complications ; Brain Ischemia - epidemiology ; C-reactive protein ; Cancer ; Cardiovascular diseases ; Decision making ; Erythrocyte sedimentation rate ; Female ; Hemoglobin ; Humans ; Ischemia ; Ischemic Stroke ; Medical records ; Medicine ; Medicine & Public Health ; Neoplasms - complications ; Neoplasms - epidemiology ; Neurology ; Neuroradiology ; Neurosciences ; Original Communication ; Patients ; Platelets ; Prognosis ; Retrospective Studies ; Risk Factors ; Stroke ; Stroke - complications ; Stroke - epidemiology ; Thromboembolism</subject><ispartof>Journal of neurology, 2021-11, Vol.268 (11), p.4190-4202</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-2f137aeec7a90175335275436c815ed9fed210c3e7965c638777ff7bb3b8f7193</citedby><cites>FETCH-LOGICAL-c474t-2f137aeec7a90175335275436c815ed9fed210c3e7965c638777ff7bb3b8f7193</cites><orcidid>0000-0002-4072-5669</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00415-021-10528-3$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00415-021-10528-3$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33945004$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Seystahl, Katharina</creatorcontrib><creatorcontrib>Hug, Alessia</creatorcontrib><creatorcontrib>Weber, Sung Ju</creatorcontrib><creatorcontrib>Kapitza, Sandra</creatorcontrib><creatorcontrib>Gramatzki, Dorothee</creatorcontrib><creatorcontrib>Wanner, Miriam</creatorcontrib><creatorcontrib>Katan, Mira</creatorcontrib><creatorcontrib>Luft, Andreas R.</creatorcontrib><creatorcontrib>Rohrmann, Sabine</creatorcontrib><creatorcontrib>Wegener, Susanne</creatorcontrib><creatorcontrib>Weller, Michael</creatorcontrib><title>Cancer is associated with inferior outcome in patients with ischemic stroke</title><title>Journal of neurology</title><addtitle>J Neurol</addtitle><addtitle>J Neurol</addtitle><description>Background
Whether patients with stroke and cancer exhibit specific characteristics has remained controversial.
Methods
Medical records of patients with ischemic stroke in 2014 or 2015 registered in the Swiss Stroke Registry of Zurich were retrospectively analyzed and integrated with regional cancer registry data. Associations of clinical and outcome parameters with cancer diagnosed up to 5 years prior to stroke were tested.
Results
Of 753 patients with ischemic stroke, 59 patients with cancer were identified. History of venous thromboembolism (
p
< 0.001) was associated with cancer while age and cardiovascular risk factors were not. Higher levels of D-dimers (
p
= 0.001), erythrocyte sedimentation rate (
p
= 0.003), C-reactive protein (CRP) (
p
< 0.001), and lower levels of hemoglobin (
p
= 0.003) were associated with cancer. For platelets, pathologically low (
p
= 0.034) or high levels (
p
< 0.001) were linked to cancer. Modified Rankin scale (mRS) scores ≥ 4 on admission and at follow-up were more frequent in cancer patients (
p
= 0.038 and
p
= 0.001). Poor post-stroke survival was associated with cancer (HR 2.2,
p
< 0.001). Multivariable analysis identified venous thromboembolism (OR 5.1), pathologic platelet count (OR = 2.9), low hemoglobin (OR 2.5) and elevated CRP (OR 1.8) as independently associated with cancer. In multivariable Cox regression, risk for death was associated with cancer (HR 1.7), low hemoglobin (HR 2.6), mRS on admission ≥ 4 (HR 1.9), pathologic platelet count (HR 1.6), female sex (HR 1.7), and elevated CRP (HR 1.4).
Conclusions
Considering cancer as a cofactor for post-stroke outcome may impact clinical decision making.</description><subject>Brain Ischemia - complications</subject><subject>Brain Ischemia - epidemiology</subject><subject>C-reactive protein</subject><subject>Cancer</subject><subject>Cardiovascular diseases</subject><subject>Decision making</subject><subject>Erythrocyte sedimentation rate</subject><subject>Female</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Ischemic Stroke</subject><subject>Medical records</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - epidemiology</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Original Communication</subject><subject>Patients</subject><subject>Platelets</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>Stroke - complications</subject><subject>Stroke - epidemiology</subject><subject>Thromboembolism</subject><issn>0340-5354</issn><issn>1432-1459</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kUFvEzEQhS0EomnaP8ChWolLLwtjjx3bl0ooKgVRiQucLceZbVyy69TeLeLfY5pQCgdOluZ98_xGj7FXHN5wAP22AEiuWhC85aCEafEZm3GJouVS2edsBiihVajkETsu5RYATBVesiNEK1XdnrFPSz8Eyk0sjS8lhehHWjff47hp4tBRjik3aRpD6qkOmp0fIw1jORAlbKiPoSljTt_ohL3o_LbQ6eGds6_vL78sP7TXn68-Lt9dt0FqObai46g9UdDeAtcKUQmtJC6C4YrWtqO14BCQtF2osECjte46vVrhynSaW5yzi73vblr1tA41UPZbt8ux9_mHSz66v5UhbtxNundGgUIrqsH5wSCnu4nK6Pp6Cm23fqA0FSeUEGgs1FBz9vof9DZNeajnVcqAEdo-UGJPhZxKydQ9huHgfnXl9l252pV76MphXTp7esbjyu9yKoB7oFRpuKH85-__2P4EYQ6fUw</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Seystahl, Katharina</creator><creator>Hug, Alessia</creator><creator>Weber, Sung Ju</creator><creator>Kapitza, Sandra</creator><creator>Gramatzki, Dorothee</creator><creator>Wanner, Miriam</creator><creator>Katan, Mira</creator><creator>Luft, Andreas R.</creator><creator>Rohrmann, Sabine</creator><creator>Wegener, Susanne</creator><creator>Weller, Michael</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4072-5669</orcidid></search><sort><creationdate>20211101</creationdate><title>Cancer is associated with inferior outcome in patients with ischemic stroke</title><author>Seystahl, Katharina ; Hug, Alessia ; Weber, Sung Ju ; Kapitza, Sandra ; Gramatzki, Dorothee ; Wanner, Miriam ; Katan, Mira ; Luft, Andreas R. ; Rohrmann, Sabine ; Wegener, Susanne ; Weller, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-2f137aeec7a90175335275436c815ed9fed210c3e7965c638777ff7bb3b8f7193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Brain Ischemia - complications</topic><topic>Brain Ischemia - epidemiology</topic><topic>C-reactive protein</topic><topic>Cancer</topic><topic>Cardiovascular diseases</topic><topic>Decision making</topic><topic>Erythrocyte sedimentation rate</topic><topic>Female</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Ischemic Stroke</topic><topic>Medical records</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - epidemiology</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Original Communication</topic><topic>Patients</topic><topic>Platelets</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>Stroke - complications</topic><topic>Stroke - epidemiology</topic><topic>Thromboembolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Seystahl, Katharina</creatorcontrib><creatorcontrib>Hug, Alessia</creatorcontrib><creatorcontrib>Weber, Sung Ju</creatorcontrib><creatorcontrib>Kapitza, Sandra</creatorcontrib><creatorcontrib>Gramatzki, Dorothee</creatorcontrib><creatorcontrib>Wanner, Miriam</creatorcontrib><creatorcontrib>Katan, Mira</creatorcontrib><creatorcontrib>Luft, Andreas R.</creatorcontrib><creatorcontrib>Rohrmann, Sabine</creatorcontrib><creatorcontrib>Wegener, Susanne</creatorcontrib><creatorcontrib>Weller, Michael</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Seystahl, Katharina</au><au>Hug, Alessia</au><au>Weber, Sung Ju</au><au>Kapitza, Sandra</au><au>Gramatzki, Dorothee</au><au>Wanner, Miriam</au><au>Katan, Mira</au><au>Luft, Andreas R.</au><au>Rohrmann, Sabine</au><au>Wegener, Susanne</au><au>Weller, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cancer is associated with inferior outcome in patients with ischemic stroke</atitle><jtitle>Journal of neurology</jtitle><stitle>J Neurol</stitle><addtitle>J Neurol</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>268</volume><issue>11</issue><spage>4190</spage><epage>4202</epage><pages>4190-4202</pages><issn>0340-5354</issn><eissn>1432-1459</eissn><abstract>Background
Whether patients with stroke and cancer exhibit specific characteristics has remained controversial.
Methods
Medical records of patients with ischemic stroke in 2014 or 2015 registered in the Swiss Stroke Registry of Zurich were retrospectively analyzed and integrated with regional cancer registry data. Associations of clinical and outcome parameters with cancer diagnosed up to 5 years prior to stroke were tested.
Results
Of 753 patients with ischemic stroke, 59 patients with cancer were identified. History of venous thromboembolism (
p
< 0.001) was associated with cancer while age and cardiovascular risk factors were not. Higher levels of D-dimers (
p
= 0.001), erythrocyte sedimentation rate (
p
= 0.003), C-reactive protein (CRP) (
p
< 0.001), and lower levels of hemoglobin (
p
= 0.003) were associated with cancer. For platelets, pathologically low (
p
= 0.034) or high levels (
p
< 0.001) were linked to cancer. Modified Rankin scale (mRS) scores ≥ 4 on admission and at follow-up were more frequent in cancer patients (
p
= 0.038 and
p
= 0.001). Poor post-stroke survival was associated with cancer (HR 2.2,
p
< 0.001). Multivariable analysis identified venous thromboembolism (OR 5.1), pathologic platelet count (OR = 2.9), low hemoglobin (OR 2.5) and elevated CRP (OR 1.8) as independently associated with cancer. In multivariable Cox regression, risk for death was associated with cancer (HR 1.7), low hemoglobin (HR 2.6), mRS on admission ≥ 4 (HR 1.9), pathologic platelet count (HR 1.6), female sex (HR 1.7), and elevated CRP (HR 1.4).
Conclusions
Considering cancer as a cofactor for post-stroke outcome may impact clinical decision making.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33945004</pmid><doi>10.1007/s00415-021-10528-3</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-4072-5669</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of neurology, 2021-11, Vol.268 (11), p.4190-4202 |
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| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8505392 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Brain Ischemia - complications Brain Ischemia - epidemiology C-reactive protein Cancer Cardiovascular diseases Decision making Erythrocyte sedimentation rate Female Hemoglobin Humans Ischemia Ischemic Stroke Medical records Medicine Medicine & Public Health Neoplasms - complications Neoplasms - epidemiology Neurology Neuroradiology Neurosciences Original Communication Patients Platelets Prognosis Retrospective Studies Risk Factors Stroke Stroke - complications Stroke - epidemiology Thromboembolism |
| title | Cancer is associated with inferior outcome in patients with ischemic stroke |
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