Outcomes in stroke patients with malignancy vary by cancer type, stroke treatment

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According to a study published in Neurology.

“Solid organ malignancy is associated with an increased incidence of acute ischemic stroke (AIS)”, ayushi Garg, medical doctor, from the Department of Neurology at the University of Iowa Hospitals and Clinics, and colleagues wrote. “There is further evidence to support that patients with malignancy also have a higher risk of early complications, disability, recurrent thromboembolic events and mortality after stroke.”

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Garg and fellow researchers sought to assess whether solid organ malignancies influence in-hospital outcomes and recurrent strokes in patients hospitalized for AIS using the National Readmissions Database to find 1,385,840 hospitalizations for SIA (average age, 70.4 years; 50.2% women) from 2016 to 2018.

The researchers compared differences in use of acute stroke interventions and clinical outcomes in patients with and without malignancy, and measured stroke severity with the Administrative Stroke Severity Index.

The primary outcome was in-hospital mortality and secondary outcomes included cerebral edema, length of hospital stay, unsystematic discharge, subarachnoid hemorrhage, and intraparenchymal hemorrhage (IPH). The researchers used survival analysis to assess the risk of readmission following recurrent stroke after discharge.

Researchers found that 3.7% (n=50,553) of hospitalizations had a co-diagnosis of malignancy of solid organs, with the five most common being lung cancer (24.6%), prostate cancer ( 13.2%), breast cancer (9.3%), pancreatic cancer. (6.5%) and colorectal cancer (6.2%). Patients with malignancy were at high risk of readmission—specifically driven by lung and pancreatic cancers—due to recurrent AIS within one year of discharge (HR=1.18; 95% CI %, 1.11-1.25).

After adjusting for baseline differences, researchers reported that patients with malignancy were also more likely to have IPH (OR=1.11; 95% CI, 1.04-1.19), mortality hospitalization (OR = 2.15; 95% CI, 2.04-2.28) and disposition at discharge other than home (OR = 1.7; 95% CI, 1.64-1.75) .

Additionally, the data showed that patients with malignancy were less likely to receive IV thrombolysis and more likely to undergo mechanical thrombectomy. Among these treatment subgroups, the results were comparable between patients with and without malignancy, with the exception of patients with lung cancer, who remained at a higher risk of mortality and adverse effects despite the acute stroke interventions.

“While patients with malignancy generally have poorer hospital outcomes than those without, there is considerable variation in these outcomes across different cancer types and the use of cancer interventions. acute stroke,” Garg and colleagues wrote.

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