Stroke-associated infections in patients with and without cancer

Katharina Seystahl; Juliane Schweizer; Mira Katan; Sung Ju Weber; Alessia Hug; Miriam Wanner; Andreas R Luft; Sabine Rohrmann; Susanne Wegener; Michael Weller

doi:10.1093/nop/npac075

Stroke-associated infections in patients with and without cancer

Neurooncol Pract. 2022 Sep 25;10(2):176-185. doi: 10.1093/nop/npac075. eCollection 2023 Apr.

Authors

Affiliations

¹ Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
² Cancer Registry of the Canton of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital and University of Zurich, Zurich, Switzerland.
³ Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.

Abstract

Background: Cancer in stroke patients is associated with higher levels of inflammatory biomarkers and unfavorable poststroke outcomes. We thus explored whether there is a link between cancer and stroke-associated infections.

Methods: Medical records of patients with ischemic stroke in 2014-2016 registered in the Swiss Stroke Registry of Zurich were retrospectively analyzed. Incidence, characteristics, treatment, and outcome of stroke-associated infections diagnosed within 7 days after stroke onset were tested for an association with cancer.

Results: Among 1181 patients with ischemic stroke, 102 patients with cancer were identified. Stroke-associated infections occurred in 179 and 19 patients (17% and 19%) without and with cancer (P = .60), respectively, among them pneumonia in 95 and 10 patients (9% and 10%) and urinary tract infections in 68 and 9 patients (6% and 9%) (P = .74 and P = .32). Use of antibiotics was similar between groups. Levels of C-reactive protein (CRP) (P < .001), erythrocyte sedimentation rate (ESR) (P = .014) and procalcitonin (P = .015) were higher and levels of albumin (P = .042) and protein (P = .031) were lower in patients with cancer than without cancer. Among patients without cancer, higher CRP (P < .001), ESR (P < .001) and procalcitonin (P = .04) and lower albumin (P < .001) were associated with stroke-associated infections. Among cancer patients with or without infections, no significant differences in these parameters were observed. In-hospital mortality was associated with cancer (P < .001) and with stroke-associated infections (P < .001). However, among patients with stroke-associated infections, cancer was not associated with in-hospital mortality (P = .24) or 30-day mortality (P = .66).

Conclusions: Cancer does not represent a risk factor for stroke-associated infections in this patient cohort.

Keywords: cancer; pneumonia; stroke; stroke-associated infections.

© The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.