全美范围内恶性肿瘤患者脑静脉血栓形成住院结局

Inpatient Outcomes of Cerebral Venous Thrombosis in Patients With Malignancy Throughout the United States

Journal of Stroke

影响因子:8.6

分区:医学1区 Top / 临床神经病学2区外周血管病2区

发表日期:2024 Sep

作者: Sima Vazqez, Ankita Das, Eris Spirollari, Paige Brabant, Bridget Nolan, Kevin Clare, Jose F Dominguez, Neha Dangayach, Krishna Amuluru, Shadi Yaghi, Ji Chong, Chaitanya Medicherla, Halla Nuoaman, Neisha Patel, Stephan A Mayer, Chirag D Gandhi, Fawaz Al-Mufti

DOI: 10.5853/jos.2023.04098

摘要

脑静脉血栓形成（CVT）与较高的发病率和死亡率相关。我们的目标是阐明癌症患者伴CVT（CA-CVT）的特征、治疗方式及结局。利用2016-2019年的国家住院样本（NIS）数据库，筛选出以CVT为主要诊断的患者，并进一步识别出伴有活动性恶性肿瘤的患者（CA-CVT）。比较CA-CVT与非CA-CVT患者的人口学特征和共存疾病。亚组分析探讨血液系统癌症与非血液系统癌症患者的情况。分析中还包括中风的严重程度及治疗措施。住院结局指标包括出院方式、住院天数和死亡率。2016至2019年间，共有6140名患者以CVT为主要诊断代码，其中370名（6.0%）伴有共同存在的恶性肿瘤。最常见的恶性肿瘤为血液系统（n=195，52.7%），其次为中枢神经系统（n=40，10.8%）、呼吸系统（n=40，10.8%）和乳腺（n=40，10.8%）。这些患者普遍年龄较非CA-CVT患者更大，且更可能伴有其他共存疾病。CA-CVT患者在国际脑静脉与硬膜窦血栓风险评分（ISCVT-RS）中表现出更高的严重程度评分和更多的并发症。在倾向评分匹配的队列中，住院结局方面未见差异。恶性肿瘤在表现为CVT的患者中发生率为6%，在未找到明确高凝状态原因的情况下，应考虑其为潜在的共存疾病。恶性肿瘤与更高的死亡率相关。然而，经调整CVT严重程度后，癌症相关CVT患者的住院结局与无癌患者相当，这表明与恶性肿瘤相关的较高死亡率可能主要由于更严重的CVT状态所致。

Abstract

Cerebral venous thrombosis (CVT) is associated with a high degree of morbidity and mortality. Our objective is to elucidate characteristics, treatments, and outcomes of patients with cancer and CVT (CA-CVT).The 2016-2019 National Inpatient Sample (NIS) database was queried for patients with a primary diagnosis of CVT. Patients with a currently active diagnosis of malignancy (CA-CVT) were then identified. Demographics and comorbidities were compared between CA-CVT and CVT patients. Subgroup analyses explored patients with hematopoietic cancer and non-hematopoietic cancers. Stroke severity and treatment were explored. Inpatient outcomes studied were discharge disposition, length of stay, and mortality.Between 2016 and 2019, 6,140 patients had a primary diagnosis code of CVT, and 370 (6.0%) patients had a coexisting malignancy. The most common malignancy was hematopoietic (n=195, 52.7%), followed by central nervous system (n=40, 10.8%), respiratory (n=40, 10.8%), and breast (n=40, 10.8%). These patients tended to be older than non-CA-CVT and were more likely to have coexisting comorbidities. CA-CVT patients had higher severity scores on the International Study of Cerebral Vein and Dural Sinus Thrombosis Risk Score (ISCVT-RS) and increased complications. In a propensity-score matched cohort, there were no differences in inpatient outcomes.Malignancy occurs in 6% of patients presenting with CVT and should be considered a potential comorbidity in instances where clear causes of hypercoagulabilty have not been identified. Malignancy was linked to higher mortality rates. Nonetheless, after adjusting for the severity of CVT, the outcomes for inpatients with cancer-associated CVT were comparable to those without cancer, indicating that the increased mortality associated with malignancy is probably due to more severe CVT conditions.