Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland.
Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
J Stroke Cerebrovasc Dis. 2022 Aug;31(8):106609. doi: 10.1016/j.jstrokecerebrovasdis.2022.106609. Epub 2022 Jun 23.
Malignancy associated acute ischemic stroke (AIS) requires specific diagnostic work-up, treatment and prevention to improve outcome. This study aimed to develop a biomarker-based score for prediction of occult malignancy in AIS patients.
Single-center cross-sectional study including consecutive AIS patients treated between July 2017 and November 2018. Patients with active malignancy at presentation, or diagnosed within 1 year thereafter and patients free of malignancy, were included and malignancy associated biomarkers were assessed. LASSO analyses of logistic regression were performed to determine biomarkers predictive of active malignancy. Predictors were derived from a predictive model for active malignancy. A comparison between known and unknown (=occult) malignancies when the index stroke occurred was used to eliminate variables not associated with occult malignancy. A predictive score (OCCULT-5 score) for occult malignancy was developed based on the remaining variables.
From 1001 AIS patients, 61 (6%) presented an active malignancy. Thirty-nine (64%) were known and 22 (36%) occult. Five variables were included in the final OCCULT-5 score: age ≥ 77 years, embolic stroke of undetermined source, multi-territorial infarcts, D-dimer levels ≥ 820 µ/gL, and female sex. A score of ≥ 3 predicted an underlying occult malignancy with a sensitivity of 64%, specificity of 73%, positive likelihood ratio of 2.35 and a negative likelihood ratio of 0.50.
The OCCULT-5 score might be useful to identify patients with occult malignancy. It may thus contribute to a more effective and timely treatment and thus lead to a positive impact on overall outcome.
与恶性肿瘤相关的急性缺血性脑卒中（AIS）需要进行特定的诊断检查、治疗和预防，以改善预后。本研究旨在开发一种基于生物标志物的评分系统，用于预测 AIS 患者隐匿性恶性肿瘤。
这是一项单中心横断面研究，纳入了 2017 年 7 月至 2018 年 11 月期间连续收治的 AIS 患者。纳入标准为：发病时存在活动性恶性肿瘤，或在随后 1 年内被诊断为恶性肿瘤，以及无恶性肿瘤的患者。评估与恶性肿瘤相关的生物标志物。采用逻辑回归的 LASSO 分析确定预测活动性恶性肿瘤的生物标志物。从预测活动性恶性肿瘤的模型中提取预测因子。当索引性脑卒中发生时，对已知和未知（=隐匿性）恶性肿瘤进行比较，以消除与隐匿性恶性肿瘤无关的变量。基于剩余变量开发了一种隐匿性恶性肿瘤的预测评分（OCCULT-5 评分）。
在 1001 例 AIS 患者中，有 61 例（6%）存在活动性恶性肿瘤。其中 39 例（64%）为已知恶性肿瘤，22 例（36%）为隐匿性恶性肿瘤。最终 OCCULT-5 评分纳入 5 个变量：年龄≥77 岁、不明来源的栓塞性脑卒中、多部位梗死、D-二聚体水平≥820 µ/gL 和女性。评分≥3 预测存在隐匿性恶性肿瘤的敏感性为 64%，特异性为 73%，阳性似然比为 2.35，阴性似然比为 0.50。
OCCULT-5 评分可用于识别隐匿性恶性肿瘤患者。因此，它可能有助于更有效地治疗和及时治疗，从而对总体预后产生积极影响。
