Spontaneous intracranial haemorrhage in critically ill patients with malignancies

Ryu, Jeong-Am; Lee, Dae Sang; Yang, Jeong Hoon; Chung, Chi Ryang; Park, Chi-Min; Suh, Gee Young; Jeon, Kyeongman

doi:10.1007/s00520-016-3094-5

Cited by 5 publications

(10 citation statements)

References 28 publications

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“…In hematological patients, the difference in mortality was recorded between positive and negative EHCT, with higher values for those with AMS as the clinical indication. The mortality of our patients with intracranial hemorrhage was in line with that reported in other studies on critically ill cancer patients (78%) 14 and in hospitalized non-oncological patients (81%). 15 , 16…”

Section: Discussionsupporting

confidence: 92%

Analysis of emergency head computed tomography in critically ill oncological patients

Pristavu

Martín

Ristescu

et al. 2021

Radiology and Oncology

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Background Critically ill cancer patients have an increased risk of developing acute neurological signs. The study objective was to evaluate the use and the usefulness of emergency head computed tomography (EHCT) in this category of patients. Patients and methods This retrospective, single-centre, cohort study included patients with EHCT performed during Intensive Care Unit (ICU) admission for a period of three years. Indications, imagistic findings, type of malignancy, and outcome were evaluated to identify diagnostic yield and correlations between abnormal findings on positive scans, malignancy type, and mortality rate. Results Sixty-four EHCTs were performed in 54 critically ill cancer patients, with 32 scans (50%) showing previously unknown lesions and considered to be positive. The most frequent abnormal findings were ischemic (15 EHCTs, 47%) and haemorrhagic (13 EHCTs, 40%) lesions. Thirty-eight EHCTs (59%) were indicated for altered mental status, with a positivity rate of 50%. Eighteen EHCTs (48%) were performed in hematological malignancy patients: 9 (50%) of which were positive with 8/9 (89%) displaying hemorrhagic lesions. Twenty EHCTs were performed in solid tumour patients, 10 (50%) of which were positive, with 9/10 (90%) displaying ischemic lesions. Out of 54 patients, 30 (55%) died during ICU stay. The mortality rate was higher in patients with hematological malignancies and positive EHCT (78% vs. 58%). Conclusions Diagnostic yield of EHCT in critically ill cancer patients is much higher than in other categories of ICU patients. We support the systematic use of EHCT in critically ill, mainly hemato-oncological patients with nonspecific neurological dysfunction, as it may lead to early identification of intracranial complications.

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Section: Discussionsupporting

confidence: 92%

Analysis of emergency head computed tomography in critically ill oncological patients

Pristavu

Martín

Ristescu

et al. 2021

Radiology and Oncology

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“…2, Studies included patients with hematological malignancy (n ¼ 31), 2,94-123 solid tumors (n ¼ 11), [124][125][126][127][128][129][130][131][132][133][134] or both (n ¼ 10). [135][136][137][138][139][140][141][142][143][144] There were 3 posthoc studies on data from randomized controlled trials, 104,117,120 2 case series 111,112 and 47 cohort studies, among which data were collected prospectively in 24 96,97,99,105-110,113,115,116,118,123,126,127 129-131,135,136,140,142,144 and obtained from medical records in 23. 2, 94,95,98,100-103,114,119,121,122,124,125,128,132-134,137-139 141,143 Platelet count only was reported in 40 studies, 2, 94,95,97,98,[100][101][102][103][104][105]107,114,[116][117][118][119][120][121...…”

Section: Resultsmentioning

confidence: 99%

“…Studies included patients with hematological malignancy ( n = 31), 2 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 solid tumors ( n = 11), 124 125 126 127 128 129 130 131 132 133 134 or both ( n = 10). 135 136 137 138 139 140 141 142 143 144 There were 3 posthoc studies on data from randomized controlled trials, 104 117 120 2 case series 111 112 and 47 cohort studies, among which data were collected prospectively in 24 96 97 99 105 106 107 108 109 110 113 115 116 118 123 126…”

Section: Resultsmentioning

confidence: 99%

“…The association between platelet count and bleeding was weaker than for hematological cancer only. 141,143 This could also indicate underlying differences in platelet function between patients with hematological cancer and those with solid tumors. However, the two studies showing no association between platelet counts and bleedings both included small study populations and a very low number of bleeding events, 140,142 probably yielding insufficient power to identify an association.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Platelets in Cancer-Related Bleeding Risk: A Systematic Review

Larsen

Højbjerg

Hvas

2019

Semin Thromb Hemost

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Cancer patients face an elevated risk of bleeding, and here platelets play a pivotal role. The association between platelet count and bleeding, as well as safe thresholds for prophylactic platelet transfusion, is described mainly in hematological malignancies, and knowledge is sparse for patients with solid tumors. Platelet function tests may further improve bleeding risk assessment in cancer patients. This study provides a systematic review of the available literature on associations between platelet count and/or function and bleeding in adult cancer patients. The review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, and Web of Science were searched up to August 2019. The National Heart, Lung, and Blood Institute's tools were used for quality assessment. In total, 52 studies investigated associations between bleeding and platelet count (n = 40) or function (n = 12) in patients with hematological malignancy (n = 31), solid tumors (n = 11), or both (n = 10). The majority of included studies rated good (n = 23) or fair (n = 25). The association between platelet count and bleeding was most pronounced at platelet counts ≤ 10 × 109/L but was less evident for solid tumors. Overall, reduced platelet function was significantly associated with bleeding risk. Thus, the available evidence supports current guidelines for prophylactic platelet transfusions at platelet count ≤ 10 × 109/L in hematological cancer patients, whereas more evidence is needed in patients with solid tumors. Platelet function analysis may be valuable in assisting bleeding risk assessment in cancer patients but is sparsely investigated so far.

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“…Given several selfsame risk factors related to stroke and cancer, both diseases may affect patients concomitantly [6,7,8]. Yet, there are very limited data - all with substantial methodological shortcomings [9,10,11] - on the interaction between ICH and cancer in relation to functional outcome.…”

Section: Introductionmentioning

confidence: 99%

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

Sprügel

Kuramatsu²,

Gerner³

et al. 2017

Cerebrovasc Dis

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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.

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Spontaneous intracranial haemorrhage in critically ill patients with malignancies

Abstract: Brain CT scanning should be performed even in critically ill cancer patients, especially with risk factors and acute neurologic changes.

Cited by 5 publications

References 28 publications

Analysis of emergency head computed tomography in critically ill oncological patients

Analysis of emergency head computed tomography in critically ill oncological patients

The Role of Platelets in Cancer-Related Bleeding Risk: A Systematic Review

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

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