Acute ischemic stroke in prostate cancer patients: Epidemiology, outcomes, and key insights from a national database.

Abstract

e17002 Background: Cancer patients, including those with prostate cancer (PCA), face an elevated risk of acute ischemic stroke (AIS) due to mechanisms such as hypercoagulability, cancer treatments like androgen deprivation therapy, and mucin production that might trigger coagulation cascades. This study examines the epidemiology and outcomes of AIS in PCA patients, addressing a critical gap in current literature. Methods: Data from the National Inpatient Sample (NIS) (2019–2021) were analyzed to identify PCA patients using ICD-10 codes. These patients were stratified by the presence or absence of concurrent AIS. Sociodemographic factors, comorbidities, and clinical outcomes were compared between patients with AIS and those without AIS. The primary endpoint was all-cause mortality, while secondary outcomes, including complications, length of stay (LOS), and hospitalization costs, were also analyzed. Multivariate regression analyses were performed using STATA version 18 to assess outcome disparities between the groups, with statistical significance set at p < 0.05. Results: Among 174,230 PCA hospitalizations, 320 (0.18%) involved AIS. AIS patients were older (71.84 vs. 67.11 years, p < 0.001) and had a higher Charlson Comorbidity Index (CCI > 2: 100% vs. 52.1%, p < 0.001). AIS significantly increased the odds of all-cause mortality (adjusted odds ratio [aOR] 7.94, 95% CI 3.52–17.90). Patients with AIS also exhibited higher odds of complications, including aspiration pneumonia (aOR 12.74, 95% CI 5.34–30.39), sepsis (aOR 6.29, 95% CI 2.66–14.85), respiratory failure (aOR 4.42, 95% CI 2.20–8.89), shock (aOR 6.53, 95% CI 2.63–16.21), pulmonary embolism (aOR 8.29, 95% CI 2.43–28.36), acute heart failure (aOR 4.89, 95% CI 1.62–14.71), and acute kidney injury (aOR 3.02, 95% CI 1.68–5.42). AIS was associated with a significantly longer hospital stay (11.45 vs. 2.90 days, adjusted incidence rate ratio [aIRR] 2.75, 95% CI 2.05–3.69) and higher hospitalization costs ($117,970 vs. $67,548, aIRR 1.72, 95% CI 1.36–2.18). Odds of new-onset seizures and home health care requirements were comparable between groups. Conclusions: PCA patients with concurrent AIS face significantly higher odds of mortality and severe complications, including aspiration pneumonia, sepsis, and respiratory failure. These findings, coupled with prolonged LOS and increased costs, highlight the urgent need for targeted management strategies to improve outcomes in this high-risk population.