Outcomes and influencing factors of acute ischemic stroke complicated with active cancer / 国际脑血管病杂志

ABSTRACT

Objective:To summarize and analyze the clinical and imaging manifestations of patients with acute ischemic stroke (AIS) and active cancer, and to investigate the influencing factors of the outcomes of patients.Methods:Patients with AIS and active cancer admitted to the Department of Neurology, Nanfang Hospital, Southern Medical University from January 2015 to December 2020 were enrolled retrospectively. At 90 d after onset, the outcomes were evaluated with the modified Rankin Scale. The patients were divided into good outcome group (0-2) and poor outcome group (>2). The clinical characteristics and imaging findings of the two groups were compared. Multivariate logistic regression model was used to determine the independent influencing factor of clinical outcomes in patients with AIS and active cancer. Results:A total of 46 patients with AIS and active cancer were enrolled, of which 37 (80.4%) had traditional vascular risk factors. Most patients showed multiple cerebral infarction (63.0%, 29/46). The most common etiological type was cryptogenic stroke (45.7%, 21/46), and the most common lesion distribution pattern was bilateral anterior circulation+ posterior circulation (47.8%, 22/46). Fourteen patients (30.4%) had a good outcome and 32 (69.6%) had a poor outcome. Multivariate logistic regression analysis showed that high D-dimer (odds ratio [ OR] 3.191, 95% confidence interval [ CI] 1.093-9.313; P=0.021) and bilateral anterior circulation+ posterior circulation cerebral infarction ( OR 10.001, 95% CI 1.224-81.718; P=0.032) were independently correlated with the poor outcomes, while high hemoglobin was independently correlated with the good outcomes ( OR 0.916, 95% CI 0.854-0.982; P=0.015). Conclusions:The etiology of AIS complicated with active cancer is mostly cryptogenic, and imaging is characterized by multiple lesions and bilateral anterior circulation+ posterior circulation involvement. Higher D-dimer and bilateral anterior circulation+ posterior circulation infarction are the risk factors for poor outcomes in patients with AIS and active cancer, while high hemoglobin is a protective factor of good outcomes.