Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke
Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke
复制标题
活动性癌症和 D-二聚体升高是院内缺血性中风的危险因素
DOI：
10.1159/000504163
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Takagi Y
中科院分区：
文献类型：
--
作者：
Yamaguchi I;Kanematsu Y;Shimada K;Korai M;Miyamoto T;Shikata E;Yamaguchi T;Yamamoto N;Yamamoto Y;Kitazato KT;Okayama Y;Takagi Y
背景和目的尽管住院脑卒中的预后差，且从发病到治疗的时间较长，但其发病机制却很少受到关注。我们研究了用于检测进展为院内缺血性卒中（IHS）的患者的病理生理学和生物标志物。他们的特征、护理和结果与933例院外缺血性卒中（OHS）患者进行了比较，这些患者使用德岛大学卒中登记处前瞻性收集的数据库。结果IHS患者的活动性癌症和冠状动脉疾病比OHS患者更普遍（分别为53.2和27.8% vs. 2.0和10.9%; p< 0.001），中位发病至评估时间较长（300 vs. 240 min; p= 0.015），未确定病因显著较高（36.7 vs. 2.4%; p< 0.001）。尽管两组患者在发病时卒中严重程度无显著差异，但IHS患者出院时改良兰金量表（mRS）评分（3-6分）（67.1 vs. 50.3%; p= 0.004）和住院期间死亡率（16.5 vs. 2.9%; p< 0.001）较高。倾向评分匹配后，IHS患者发病时的D-二聚体（5.8 vs. 0.8 µg/mL; p< 0.001）和纤维蛋白原（532 vs. 430 mg/dL; p= 0.014）血浆水平显著较高。多因素Logistic回归分析显示，活动性癌症（比值比[OR] 2.30; 95%置信区间[CI] 1.26-4.20），卒中前mRS评分3-5（OR 6.78; 95% CI 3.96-11.61），女性（OR 1.57; 95% CI 1.19-2.08），年龄≥ 75岁（OR 2.36; 95% CI 1.80-3.08）IHS患者的预后比OHS患者差，因为活动性癌症的患病率更高，中风发作前的功能依赖血浆D-二聚体和纤维蛋白原水平升高，尤其是活动性癌症患者，可以帮助识别进展为IHS的风险较高的患者。
Background and PurposeLittle 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).MethodsSeventy-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.ResultsActive 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.ConclusionsPatients 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.