Outcomes and its influencing factors of ischemic stroke patients with lung cancer / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the outcomes and its influencing factors of ischemic stroke patients with lung cancer.Methods:Patients with acute ischemic stroke complicated with lung cancer admitted to the Department of Neurology, Ninghe District Hospital of Tianjin from January 2017 to December 2020 were retrospectively enrolled. The demographic and baseline clinical data were collected. The main outcome measure was the clinical outcome evaluated by the modified Rankin Scale at 90 days after the onset of ischemic stroke. 0-2 was defined as a good outcome, and 3-6 was defined as a poor outcome. The secondary outcome measures were bleeding events within 90 d after the onset of ischemic stroke, including hemorrhagic transformation and hemoptysis.Results:A total of 37 patients were enrolled, including 25 males (68%) and 12 females (32%); age 72.6±8.0 years; 23 patients (62.2%) had a good outcome and 14 (37.8%) had a poor outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score and the proportions of patients with stage Ⅳ lung cancer, cerebral infarction due to other causes, moderate and severe stroke, anterior + posterior circulation cerebral infarction, bilateral cerebral infarction and multiple cerebral infarction in the poor outcome group were significantly higher than those in the good outcome group, while the proportion of patients with minor stroke, stage Ⅲ lung cancer and intravenous thrombolysis were significantly lower than those of patients with good outcomes (all P<0.05). Multivariate logistic regression analysis showed that the high baseline NIHSS score (odd ratio [ OR] 1.342, 95% confidence interval [ CI] 1.219-1.586; P=0.018], stage Ⅳ lung cancer ( OR 1.180, 95% CI 1.088-2.187; P=0.042), severe stroke ( OR 1.216, 95% CI 1.008-2.136; P=0.037) and multiple cerebral infarction ( OR 1.508, 95% CI 1.005-1.516; P<0.001) were independently associated with the poor outcomes, while intravenous thrombolytic therapy ( OR 0.572, 95% CI 0.262-0.802; P=0.001) was independently associated with the good outcomes. In addition, the incidence of hemorrhagic transformation and hemoptysis in intravenous thrombolytic patients was significantly higher than that in the non-intravenous thrombolytic patients (all P<0.05). Conclusions:Higher baseline NIHSS scores, multiple cerebral infarction and advanced lung cancer are associated with the poor outcomes in patients with lung cancer and ischemic stroke; intravenous thrombolytic therapy is associated with good outcomes, although it increased the risk of bleeding.