Score for Predicting Active Cancer in Patients with Ischemic Stroke: A Retrospective Study

Abstract

Background: We aimed to examine the differences between the clinical characteristics of patients with ischemic stroke and active cancer and those without cancer and develop a clinical score for predicting occult cancer in patients with ischemic stroke.Methods: This retrospective study enrolled consecutive adult patients with acute ischemic stroke, who were admitted to our department between December 2017 and January 2019. The demographic, clinical, laboratory, and neuroimaging characteristics of patients with ischemic stroke with active cancer and those without cancer were compared. Multivariate analysis was performed to identify independent factors associated with active cancer. Subsequently, a predictive cancer-risk score was developed using the area under the receiver operating characteristic curve.Results: Fifty-three (6.63%) of 799 patients with ischemic stroke had active cancer. The absence of a history of hyperlipidemia [odds ratio (OR)=0.17, 95% confidence interval (CI): 0.06–0.48, P<0.01], elevated serum fibrinogen (OR=1.72, 95% CI: 1.33–2.22, P<0.01) and D-dimer levels (OR=1.43, 95% CI: 1.24–1.64, P<0.01), and stroke of undetermined etiology (OR=22.87, 95% CI: 9.91–52.78, P<0.01) were independently associated with active cancer. Thus, a score based on the absence of hyperlipidemia and serum fibrinogen ≥4.00 g/L and D-dimer ≥2.00 μg/mL predicted active cancer with an area under the curve of 0.83 (95% CI: 0.77–0.89, P<0.01). The probability of active cancer was 59% at a supposed prevalence of 6.63%, if all three independent factors were present in a patient with ischemic stroke.Conclusions: We devised a score to predict active cancer in patients with ischemic stroke based on the absence of a history of hyperlipidemia and elevated serum D-dimer and fibrinogen that highlights the importance of hypercoagulability in these patients and may help determine early intervention and management.

The Index of Esophageal Cancer Related Ischemic Stroke: A Retrospective Patient Control Study

“…Previous studies have made a variety of efforts, and these studies have evaluated several factors, such as increased levels of DD, C-reactive protein and neutrophil/lymphocyte ratio in the blood and the presence of multiple ischemic lesions in neuroimaging, which have been used as biomarkers of cancer-related ischemic stroke. [27][28][29][30] However, due to the lack of specific substances or measures, the precise measures to identify cancer-related cerebral infarction are still unclear. In this study, considering that the three independent risk factors for ECIS may play their own roles or may play a role together as a factor in the development of ECIS, we established an ROC curve to identify the factors that play the greatest role in the development of ECIS.…”