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Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke

BACKGROUND: Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stage...

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Autores principales: Nam, Ki-Woong, Kim, Chi Kyung, Kim, Tae Jung, An, Sang Joon, Oh, Kyungmi, Mo, Heejung, Kang, Min Kyoung, Han, Moon-Ku, Demchuk, Andrew M., Ko, Sang-Bae, Yoon, Byung-Woo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345775/
https://www.ncbi.nlm.nih.gov/pubmed/28282388
http://dx.doi.org/10.1371/journal.pone.0172793
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author Nam, Ki-Woong
Kim, Chi Kyung
Kim, Tae Jung
An, Sang Joon
Oh, Kyungmi
Mo, Heejung
Kang, Min Kyoung
Han, Moon-Ku
Demchuk, Andrew M.
Ko, Sang-Bae
Yoon, Byung-Woo
author_facet Nam, Ki-Woong
Kim, Chi Kyung
Kim, Tae Jung
An, Sang Joon
Oh, Kyungmi
Mo, Heejung
Kang, Min Kyoung
Han, Moon-Ku
Demchuk, Andrew M.
Ko, Sang-Bae
Yoon, Byung-Woo
author_sort Nam, Ki-Woong
collection PubMed
description BACKGROUND: Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. AIM: In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. METHODS: We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. RESULTS: Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46–3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00–1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10–8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. CONCLUSIONS: D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.
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spelling pubmed-53457752017-03-30 Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke Nam, Ki-Woong Kim, Chi Kyung Kim, Tae Jung An, Sang Joon Oh, Kyungmi Mo, Heejung Kang, Min Kyoung Han, Moon-Ku Demchuk, Andrew M. Ko, Sang-Bae Yoon, Byung-Woo PLoS One Research Article BACKGROUND: Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. AIM: In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. METHODS: We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. RESULTS: Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46–3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00–1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10–8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. CONCLUSIONS: D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer. Public Library of Science 2017-03-10 /pmc/articles/PMC5345775/ /pubmed/28282388 http://dx.doi.org/10.1371/journal.pone.0172793 Text en © 2017 Nam et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Nam, Ki-Woong
Kim, Chi Kyung
Kim, Tae Jung
An, Sang Joon
Oh, Kyungmi
Mo, Heejung
Kang, Min Kyoung
Han, Moon-Ku
Demchuk, Andrew M.
Ko, Sang-Bae
Yoon, Byung-Woo
Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke
title Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke
title_full Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke
title_fullStr Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke
title_full_unstemmed Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke
title_short Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke
title_sort predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345775/
https://www.ncbi.nlm.nih.gov/pubmed/28282388
http://dx.doi.org/10.1371/journal.pone.0172793
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