title: D-dimer as a predictor of early neurologic deterioration in cryptogenic stroke with active cancer.
abstract: The occurrence of stroke in cancer patients is caused by conventional vascular risk factors and cancer-specific mechanisms. However, cryptogenic stroke in patients with cancer was considered to be more related to cancer-specific hypercoagulability. In this study, we investigated the potential of the D-dimer level to serve as a predictor of early neurologic deterioration (END) in cryptogenic stroke patients with active cancer.
  
  
  
  We recruited 109 cryptogenic stroke patients with active cancer within 72 h of symptom onset. We defined END as an increase of ≥1 point in the motor National Institutes of Health Stroke Scale (NIHSS) score or ≥2 points in the total NIHSS score within 72 h of admission. After adjusting for potential confounding factors in the multivariate analysis, we calculated the odds ratios (ORs) and confidence intervals (CIs) of D-dimer in the prediction of END.
  
  
  
  Among 109 patients, END events were identified in 34 (31%) patients within 72 h. END was significantly associated with systemic metastasis, multiple vascular territory lesions on the initial magnetic resonance imaging (MRI), initial NIHSS score and D-dimer levels. In the multivariate analysis, the D-dimer level (adjusted OR, 1.11; 95% CI, 1.04-1.17; P < 0.01) and initial NIHSS score (adjusted OR, 1.08; 95% CI, 1.01-1.15; P = 0.03) predicted END after adjusting for potential confounding factors. In the subgroup analysis of 72 follow-up MRIs, D-dimer level was also correlated with new territory lesions on the follow-up MRI in a dose-dependent manner.
  
  
  
  Ischemic stroke patients with active cancer and elevated D-dimer levels appear to be at increased risk for END recurrent thromboembolic stroke.
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: K-W
authors.initials: KW
authors.lastname: Nam
authors.affiliation: Department of Neurology, Korea University Guro Hospital, Seoul, Korea.|Calgary Stroke Program, Department of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: C K
authors.initials: CK
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: T J
authors.initials: TJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: S J
authors.initials: SJ
authors.lastname: An
authors.affiliation: Calgary Stroke Program, Department of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Y
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: S
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: M-K
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: S-B
authors.initials: SB
authors.lastname: Ko
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: B-W
authors.initials: BW
authors.lastname: Yoon
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D013997:Time Factors
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: cerebral infarction; hypercoagulability; neoplasm; prognosis; stroke