Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke
Background and Purpose: Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). Methods: S...
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doaj-535e98993355439b8cc7ec02b7ea7aa72020-11-25T03:34:15ZengKarger PublishersCerebrovascular Diseases Extra1664-54562019-11-019312913810.1159/000504163504163Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic StrokeIzumi YamaguchiYasuhisa KanematsuKenji ShimadaMasaaki KoraiTakeshi MiyamotoEiji ShikataTadashi YamaguchiNobuaki YamamotoYuki YamamotoKeiko T. KitazatoYoshihiro OkayamaYasushi TakagiBackground and Purpose: Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). Methods: Seventy-nine patients with IHS were sequentially recruited in the period 2011–2017. Their characteristics, care, and outcomes were compared with 933 patients who had an out-of-hospital ischemic stroke (OHS) using a prospectively collected database of the Tokushima University Stroke Registry. Results: Active cancer and coronary artery disease were more prevalent in patients with IHS than in those with OHS (53.2 and 27.8% vs. 2.0 and 10.9%, respectively; p < 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; p = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; p < 0.001). Although there was no significant difference in stroke severity at onset between the groups, patients with IHS had higher modified Rankin Scale (mRS) scores (3–6) at discharge (67.1 vs. 50.3%; p = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; p < 0.001). D-dimer (5.8 vs. 0.8 µg/mL; p < 0.001) and fibrinogen (532 vs. 430 mg/dL; p = 0.014) plasma levels at the time of onset were significantly higher in patients with IHS after propensity score matching. Multivariate logistic regression analysis revealed that active cancer (odds ratio [OR] 2.30; 95% confidence interval [CI] 1.26–4.20), prestroke mRS scores 3–5 (OR 6.78; 95% CI 3.96–11.61), female sex (OR 1.57; 95% CI 1.19–2.08), and age ≥75 years (OR 2.36; 95% CI 1.80–3.08) were associated with poor outcomes. Conclusions: Patients with IHS had poorer outcomes than those with OHS because of a higher prevalence of active cancer and functional dependence before stroke onset. Elevated plasma levels of D-dimer and fibrinogen, especially with active cancer, can help identify patients who are at a higher risk of progression to IHS.https://www.karger.com/Article/FullText/504163in-hospital strokecancerd-dimerfibrinogenhypercoagulability |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Izumi Yamaguchi Yasuhisa Kanematsu Kenji Shimada Masaaki Korai Takeshi Miyamoto Eiji Shikata Tadashi Yamaguchi Nobuaki Yamamoto Yuki Yamamoto Keiko T. Kitazato Yoshihiro Okayama Yasushi Takagi |
spellingShingle |
Izumi Yamaguchi Yasuhisa Kanematsu Kenji Shimada Masaaki Korai Takeshi Miyamoto Eiji Shikata Tadashi Yamaguchi Nobuaki Yamamoto Yuki Yamamoto Keiko T. Kitazato Yoshihiro Okayama Yasushi Takagi Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke Cerebrovascular Diseases Extra in-hospital stroke cancer d-dimer fibrinogen hypercoagulability |
author_facet |
Izumi Yamaguchi Yasuhisa Kanematsu Kenji Shimada Masaaki Korai Takeshi Miyamoto Eiji Shikata Tadashi Yamaguchi Nobuaki Yamamoto Yuki Yamamoto Keiko T. Kitazato Yoshihiro Okayama Yasushi Takagi |
author_sort |
Izumi Yamaguchi |
title |
Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke |
title_short |
Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke |
title_full |
Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke |
title_fullStr |
Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke |
title_full_unstemmed |
Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke |
title_sort |
active cancer and elevated d-dimer are risk factors for in-hospital ischemic stroke |
publisher |
Karger Publishers |
series |
Cerebrovascular Diseases Extra |
issn |
1664-5456 |
publishDate |
2019-11-01 |
description |
Background and Purpose: Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). Methods: Seventy-nine patients with IHS were sequentially recruited in the period 2011–2017. Their characteristics, care, and outcomes were compared with 933 patients who had an out-of-hospital ischemic stroke (OHS) using a prospectively collected database of the Tokushima University Stroke Registry. Results: Active cancer and coronary artery disease were more prevalent in patients with IHS than in those with OHS (53.2 and 27.8% vs. 2.0 and 10.9%, respectively; p < 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; p = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; p < 0.001). Although there was no significant difference in stroke severity at onset between the groups, patients with IHS had higher modified Rankin Scale (mRS) scores (3–6) at discharge (67.1 vs. 50.3%; p = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; p < 0.001). D-dimer (5.8 vs. 0.8 µg/mL; p < 0.001) and fibrinogen (532 vs. 430 mg/dL; p = 0.014) plasma levels at the time of onset were significantly higher in patients with IHS after propensity score matching. Multivariate logistic regression analysis revealed that active cancer (odds ratio [OR] 2.30; 95% confidence interval [CI] 1.26–4.20), prestroke mRS scores 3–5 (OR 6.78; 95% CI 3.96–11.61), female sex (OR 1.57; 95% CI 1.19–2.08), and age ≥75 years (OR 2.36; 95% CI 1.80–3.08) were associated with poor outcomes. Conclusions: Patients with IHS had poorer outcomes than those with OHS because of a higher prevalence of active cancer and functional dependence before stroke onset. Elevated plasma levels of D-dimer and fibrinogen, especially with active cancer, can help identify patients who are at a higher risk of progression to IHS. |
topic |
in-hospital stroke cancer d-dimer fibrinogen hypercoagulability |
url |
https://www.karger.com/Article/FullText/504163 |
work_keys_str_mv |
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