Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer
Background: Paraneoplastic ischemic stroke has a poor prognosis. We have recently reported an algorithm based on the number of ischemic territories, C-reactive protein (CRP), lactate dehydrogenase (LDH), and granulocytosis to predict the underlying active cancer in a case-control setting. However, c...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-04-01
|
| Series: | Therapeutic Advances in Neurological Disorders |
| Online Access: | https://doi.org/10.1177/17562864241239123 |
| _version_ | 1797216598448144384 |
|---|---|
| author | Rebecca Kassubek Marc-Andre G. R. Winter Jens Dreyhaupt Mona Laible Jan Kassubek Albert C. Ludolph Jan Lewerenz |
| author_facet | Rebecca Kassubek Marc-Andre G. R. Winter Jens Dreyhaupt Mona Laible Jan Kassubek Albert C. Ludolph Jan Lewerenz |
| author_sort | Rebecca Kassubek |
| collection | DOAJ |
| description | Background: Paraneoplastic ischemic stroke has a poor prognosis. We have recently reported an algorithm based on the number of ischemic territories, C-reactive protein (CRP), lactate dehydrogenase (LDH), and granulocytosis to predict the underlying active cancer in a case-control setting. However, co-occurrence of cancer and stroke might also be merely incidental. Objective: To detect cancer-associated ischemic stroke in a large, unselected cohort of consecutive stroke patients by detailed analysis of ischemic stroke associated with specific cancer subtypes and comparison to patients with bacterial endocarditis. Methods: Retrospective single-center cohort study of consecutive 1612 ischemic strokes with magnetic resonance imaging, CRP, LDH, and relative granulocytosis data was performed, including identification of active cancers, history of now inactive cancers, and the diagnosis of endocarditis. The previously developed algorithm to detect paraneoplastic cancer was applied. Tumor types associated with paraneoplastic stroke were used to optimize the diagnostic algorithm. Results: Ischemic strokes associated with active cancer, but also endocarditis, were associated with more ischemic territories as well as higher CRP and LDH levels. Our previous algorithm identified active cancer-associated strokes with a specificity of 83% and sensitivity of 52%. Ischemic strokes associated with lung, pancreatic, and colorectal (LPC) cancers but not with breast and prostate cancers showed more frequent and prominent characteristics of paraneoplastic stroke. A multiple logistic regression model optimized to identify LPC cancers detected active cancer with a sensitivity of 77.8% and specificity of 81.4%. The positive predictive value (PPV) for all active cancers was 13.1%. Conclusion: Standard clinical examinations can be employed to identify suspect paraneoplastic stroke with an adequate sensitivity, specificity, and PPV when it is considered that the association of ischemic stroke with breast and prostate cancers in the stroke-prone elderly population might be largely incidental. |
| first_indexed | 2024-04-24T11:48:30Z |
| format | Article |
| id | doaj.art-de6fb72b6c904dcbbb74a005794a78e1 |
| institution | Directory Open Access Journal |
| issn | 1756-2864 |
| language | English |
| last_indexed | 2024-04-24T11:48:30Z |
| publishDate | 2024-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Neurological Disorders |
| spelling | doaj.art-de6fb72b6c904dcbbb74a005794a78e12024-04-09T09:04:07ZengSAGE PublishingTherapeutic Advances in Neurological Disorders1756-28642024-04-011710.1177/17562864241239123Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancerRebecca KassubekMarc-Andre G. R. WinterJens DreyhauptMona LaibleJan KassubekAlbert C. LudolphJan LewerenzBackground: Paraneoplastic ischemic stroke has a poor prognosis. We have recently reported an algorithm based on the number of ischemic territories, C-reactive protein (CRP), lactate dehydrogenase (LDH), and granulocytosis to predict the underlying active cancer in a case-control setting. However, co-occurrence of cancer and stroke might also be merely incidental. Objective: To detect cancer-associated ischemic stroke in a large, unselected cohort of consecutive stroke patients by detailed analysis of ischemic stroke associated with specific cancer subtypes and comparison to patients with bacterial endocarditis. Methods: Retrospective single-center cohort study of consecutive 1612 ischemic strokes with magnetic resonance imaging, CRP, LDH, and relative granulocytosis data was performed, including identification of active cancers, history of now inactive cancers, and the diagnosis of endocarditis. The previously developed algorithm to detect paraneoplastic cancer was applied. Tumor types associated with paraneoplastic stroke were used to optimize the diagnostic algorithm. Results: Ischemic strokes associated with active cancer, but also endocarditis, were associated with more ischemic territories as well as higher CRP and LDH levels. Our previous algorithm identified active cancer-associated strokes with a specificity of 83% and sensitivity of 52%. Ischemic strokes associated with lung, pancreatic, and colorectal (LPC) cancers but not with breast and prostate cancers showed more frequent and prominent characteristics of paraneoplastic stroke. A multiple logistic regression model optimized to identify LPC cancers detected active cancer with a sensitivity of 77.8% and specificity of 81.4%. The positive predictive value (PPV) for all active cancers was 13.1%. Conclusion: Standard clinical examinations can be employed to identify suspect paraneoplastic stroke with an adequate sensitivity, specificity, and PPV when it is considered that the association of ischemic stroke with breast and prostate cancers in the stroke-prone elderly population might be largely incidental.https://doi.org/10.1177/17562864241239123 |
| spellingShingle | Rebecca Kassubek Marc-Andre G. R. Winter Jens Dreyhaupt Mona Laible Jan Kassubek Albert C. Ludolph Jan Lewerenz Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer Therapeutic Advances in Neurological Disorders |
| title | Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer |
| title_full | Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer |
| title_fullStr | Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer |
| title_full_unstemmed | Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer |
| title_short | Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer |
| title_sort | development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung pancreatic and colorectal cancer |
| url | https://doi.org/10.1177/17562864241239123 |
| work_keys_str_mv | AT rebeccakassubek developmentofanalgorithmforidentifyingparaneoplasticischemicstrokeinassociationwithlungpancreaticandcolorectalcancer AT marcandregrwinter developmentofanalgorithmforidentifyingparaneoplasticischemicstrokeinassociationwithlungpancreaticandcolorectalcancer AT jensdreyhaupt developmentofanalgorithmforidentifyingparaneoplasticischemicstrokeinassociationwithlungpancreaticandcolorectalcancer AT monalaible developmentofanalgorithmforidentifyingparaneoplasticischemicstrokeinassociationwithlungpancreaticandcolorectalcancer AT jankassubek developmentofanalgorithmforidentifyingparaneoplasticischemicstrokeinassociationwithlungpancreaticandcolorectalcancer AT albertcludolph developmentofanalgorithmforidentifyingparaneoplasticischemicstrokeinassociationwithlungpancreaticandcolorectalcancer AT janlewerenz developmentofanalgorithmforidentifyingparaneoplasticischemicstrokeinassociationwithlungpancreaticandcolorectalcancer |