title: Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ki-Woong
authors.initials: KW
authors.lastname: Nam
authors.affiliation: Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, Seoul, Korea.|Calgary Stroke Program, Department of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: Chi Kyung
authors.initials: CK
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Tae Jung
authors.initials: TJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: An
authors.affiliation: Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, Seoul, Korea.
authors.forename: Kyungmi
authors.initials: K
authors.lastname: Oh
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Heejung
authors.initials: H
authors.lastname: Mo
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Min Kyoung
authors.initials: MK
authors.lastname: Kang
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Calgary Stroke Program, Department of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang-Bae
authors.initials: SB
authors.lastname: Ko
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Byung-Woo
authors.initials: BW
authors.lastname: Yoon
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016017:Odds Ratio; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality; D015996:Survival Rate; D013923:Thromboembolism / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein