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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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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. |
format | Online Article Text |
id | pubmed-5345775 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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