Pre-Stroke Disability, Stroke Severity and Systemic Inflammation Outweigh Malignancy as Determinants of 90-Day Outcome After Acute Ischemic Stroke: A Single-Center Retrospective Cohort Study

Abstract

Background/Objectives: Patients with acute ischemic stroke (AIS) and coexisting malignancy have worse outcomes, but it is unclear how much of this reflects malignancy itself rather than pre-stroke function, stroke severity and systemic inflammation. Methods: We retrospectively studied consecutive adults with MRI-confirmed AIS admitted to a neurology department in Warsaw, Poland (2020–2024): 130 with documented malignancy and 100 without. Because every patient with a pre-stroke modified Rankin Scale (mRS) score above 2 had a poor outcome by definition, the primary analysis was restricted to patients with pre-stroke mRS 0–2 (n = 161; 80 versus 81). Logistic models were adjusted sequentially for age, sex, admission NIHSS, pre-stroke mRS and log-transformed C-reactive protein (CRP). Results: Groups were comparable in age and vascular comorbidities. Good 90-day outcome was less frequent with malignancy (40.0% versus 58.0%; p = 0.028), but the association was no longer significant after adjustment for age, sex and admission NIHSS (odds ratio [OR] 1.55, 95% CI 0.69–3.51) and was null after adding pre-stroke mRS and log-CRP (OR 0.67, 0.25–1.81). Admission NIHSS and log-CRP were the consistent independent predictors. Return to within one mRS point of baseline was achieved by 41.5% versus 59.0% (p = 0.011). Among patients with pre-stroke mRS ≤ 2, intravenous thrombolysis rates were similar (22.5% versus 22.2%) and hemorrhagic transformation did not differ (17.4% versus 18.9%). Conclusions: Malignancy added little prognostic information beyond baseline function, stroke severity and systemic inflammation, although a clinically meaningful residual effect cannot be excluded. Among eligible patients, reperfusion appeared equally safe.