Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage

Abstract

Background: Data on clinical characteristics and outcome of patients with intracerebral hemorrhage (ICH) and concomitant systemic cancer disease are very limited. Methods: Nine hundred and seventy three consecutive primary ICH patients were analyzed using our prospective institutional registry over a period of 9 years (2006-2014). We compared clinical and radiological parameters as well as outcome - scored using the modified Rankin Scale (mRS) and analyzed in a dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable outcome (mRS = 4-6) - of ICH patients with and without cancer. Relevant imbalances in baseline clinical and radiological characteristics were adjusted using propensity score (PS) matching. Results: Prevalence of systemic cancer among patients with ICH was 8.5% (83/973). ICH patients with cancer were older (77 [70-82] vs. 72 [63-80] years; p = 0.002), had more often prior renal dysfunction (19/83 [22.9%] vs.107/890 [12.0%]; p = 0.005), and smaller hemorrhage volumes (10.1 [4.8-24.3] vs. 15.3 [5.4-42.9] mL; p = 0.017). After PS-matching there were no significant differences neither in mortality nor in functional outcome both at 3 months (mortality: 33/81 [40.7%] vs. 55/158 [34.8%]; p = 0.368; mRS = 0-3: 28/81 [34.6%] vs. 52/158 [32.9%]; p = 0.797) and 12 months (mortality: 39/78 [50.0%] vs. 70/150 [46.7%]; p = 0.633; mRS = 0-3: 25/78 [32.1%] vs. 53/150 [35.3%]; p = 0.620) among patients with and without concomitant systemic cancer. ICH volume tended to be highest in patients with hematooncologic malignancy and smallest in urothelial cancer. Conclusions: Patients with ICH and concomitant systemic cancer on average are older; however, they show smaller ICH volumes compared to patients without cancer. Yet, mortality and functional outcome is not different in ICH patients with and without cancer. Thus, the clinical history or the de novo diagnosis of concomitant malignancies in ICH patients should not lead to unjustified treatment restrictions.

Age-dependent clinical outcomes in primary versus oral anticoagulation-related intracerebral hemorrhage

“…Detailed information and methods of the multicenter RETRACE program (part 1 recruited patients from 1 January 2006 until 31 December 2010 (NCT01829581) and part 2 from 1 January 2011 until 31 December 2015 (NCT03093233)) and the prospective UKER-ICH registry (NCT03183167) have been published previously. [14][15][16][17][18] The study was approved by the local ethics committees and institutional review boards based on the central vote from Friedrich-Alexander-University Erlangen-Nuremberg, Germany (Re.No-4409 & 30_16B, 115_17B). Written consent was obtained by patients or legal representatives.…”

Cancer and stroke: commonly encountered by clinicians, but little evidence to guide clinical approach

“…Previous studies have shown no difference in ICH patients with and without cancer with respect to in-hospital mortality, short- and long-term outcome, and the proportion of patients with favorable functional outcome over a period of 12 months after ICH. 20 , 85 A possible reason why additional cancer diagnosis did not impact long-term prognosis after ICH was likely the importance of the severity of the bleeding itself. 85 Other studies have shown, on the contrary, higher odds of death and lower odds of favorable discharge in ICH patients with cancer.…”

Blood Pressure and Anticoagulation Reversal Management during Off-Hours in Oral Anticoagulation-Associated Intracerebral Hemorrhage

“…Detailed information and methods of the multicenter RE-TRACE program (part 1 recruited patients from January 1, 2006, until December 31, 2010 [NCT01829581] and part 2 from January 1, 2011, until December 31, 2015 [NCT03093233]) have been published previously [3,[12][13][14][15].…”

“…Demographic, clinical, and laboratory data were collected as previously described [12]. Medical history of arterial hypertension, diabetes mellitus, prior stroke, congestive heart failure, abnormal kidney, and premorbid modified Rankin Scale (mRS) were assessed [17].…”

“…1 . Off-hours VKA-ICH patients showed a significant higher National Institutes of Health Stroke Scale (NIHSS), (13 [6-21] vs. 10 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]; p < 0.01), a reduced Glasgow Coma Scale-Score (13 [10][11][12][13][14][15] vs. 14 [11][12][13][14][15]; p = 0.01), and a higher rate of intraventricular hemorrhage (447 [44.5%] vs. 108 [38.7%], p < 0.05) compared to on-hour VKA patients (Table 1). There was no difference regarding the time from symptom onset to hospital admission between on-and offhour VKA patients (98 min [60-266 min] vs. 101 min [60-260 min]; p = 0.97).…”