title: Poor short-term outcome in patients with ischaemic stroke and active cancer.
abstract: Stroke risk is increased in cancer patients and cancer activity has been claimed to play a role in the development of ischaemic stroke (IS). We wanted to further test these assumptions and to explore the impact of such relation on short-term prognosis. We identified all IS patients that were admitted to the neurological department of our primary and tertiary care university hospital between 2008 and 2014 (n = 4918) and reviewed their medical records for an additional diagnosis of cancer. Cancer patients were categorized into those with "active cancer" (AC: recurrent malignant tumour, metastases, ongoing chemo-/radiotherapy) and "non-active cancer" (NAC). We compared demographic, clinical and neuroimaging features of both patient groups and assessed their association with in-hospital mortality. 300 IS patients with known cancer were identified (AC: n = 73; NAC: n = 227). IS patients with AC were significantly younger (70.3 ± 10.6 vs. 74.9 ± 9.9 years), had more severe strokes at admission (NIHSS: median 5 vs. 3), more frequently cryptogenic strokes (50.7 vs. 32.5 %) and more often infarcts in multiple vascular territories of the brain (26 vs. 5.2 %) compared to IS patients with NAC. In-hospital mortality was significantly higher in AC patients (21.9 vs. 6.2 %). Multivariate analysis identified AC (odds ratio [OR] 3.70, 95 % confidence interval [CI] 1.50-9.30), NIHSS at admission (OR 1.10, CI 1.10-1.20) and C-reactive protein level (OR 1.01, CI 1.00-1.02) as factors significantly and independently associated with in-hospital death. Our findings support a direct role of AC in the pathogenesis and prognosis of acute IS. This needs to be considered in the management and counselling of such patients.
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Kneihsl
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.|Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Enzinger
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
authors.forename: Gerit
authors.initials: G
authors.lastname: Wünsch
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Khalil
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
authors.forename: Valeriu
authors.initials: V
authors.lastname: Culea
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
authors.forename: Tadeja
authors.initials: T
authors.lastname: Urbanic-Purkart
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Payer
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Niederkorn
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.affiliation: Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria. thomas.gattringer@medunigraz.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gattringer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology*
keywords: Cancer; Clinical neurology; Ischaemic stroke; Outcome