徳島大学 教育・研究者情報データベース(EDB)

1. 山口 泉

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2. 兼松 康久

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3. 島田 健司([徳島大学.病院.先端医科医療開発研究プロジェクト]/[徳島大学.病院.診療科.脳·神経·精神科.脳神経外科])

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4. 高麗 雅章([徳島大学.大学院医歯薬学研究部.医学域.先端医学教育研究プロジェクト]/[徳島大学.大学院医歯薬学研究部.医学域.医科学部門.外科系.脳神経外科学])

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5. 宮本 健志([徳島大学.大学院医歯薬学研究部.医学域.先端医学教育研究プロジェクト]/[徳島大学.大学院医歯薬学研究部.医学域.医科学部門.外科系.脳神経外科学])

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6. (英) Shikata Eiji / (日) 四方 英二 / (読) しかた えいじ

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7. (英) Yamaguchi Tadashi / (日) 山口 真司 / (読) やまぐち ただし

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8. 山本 伸昭

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9. (英) Yamamoto Yuki / (日) 山本 雄貴 / (読) やまもと ゆうき

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10. (英) Kitazato Keiko / (日) 北里 慶子 / (読) きたざと けいこ

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11. (英) Okayama Yoshihiro

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12. 髙木 康志([徳島大学.大学院医歯薬学研究部.医学域.医科学部門.外科系.脳神経外科学])

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(英) Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke

(英) Little 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). Seventy-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. Active 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. Patients 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.

1. (英) Aged
2. (英) Aged, 80 and over
3. (英) Biomarkers
4. (英) Brain Ischemia
5. (英) Databases, Factual
6. 女性(female)
7. (英) Fibrin Fibrinogen Degradation Products
8. (英) Hospital Mortality
9. (英) Hospitalization
10. (英) Humans
11. (英) Inpatients
12. 日本(Japan)
13. 男性(male)
14. (英) Middle Aged
15. (英) Neoplasms
16. (英) Prevalence
17. (英) Prognosis
18. (英) Registries
19. (英) Retrospective Studies
20. (英) Risk Assessment
21. (英) Risk Factors
22. (英) Stroke
23. (英) Time Factors
24. (英) Up-Regulation

1. (英) Article.ELocationID: 10.1159/000504163

2. (英) Article.PublicationTypeList.PublicationType: Journal Article

3. (英) KeywordList.Keyword: Cancer

4. (英) KeywordList.Keyword: D-dimer

5. (英) KeywordList.Keyword: Fibrinogen

6. (英) KeywordList.Keyword: Hypercoagulability

7. (英) KeywordList.Keyword: In-hospital stroke