Serum fibrinogen levels and the CRP-to-fibrinogen ratio as predictors of short-term mortality in acute ischemic stroke with active cancer

Abstract Background and Purpose Short-term outcomes in cancer-related ischemic stroke have been linked to elevated serum D-dimer levels and multiple vascular lesions, as well as decreased serum fibrinogen levels. The C-reactive protein-to-fibrinogen ratio (CFR) has also been identified as a useful marker in the diagnosis and prognosis of disseminated intravascular coagulation. This study aimed to evaluate the associations between serum fibrinogen levels (SFLs) and the CFR with short-term mortality in patients with acute ischemic stroke and active cancer. Methods Serum samples were retrospectively collected on admission from patients with acute ischemic stroke and active cancer. Active cancer was defined as a newly diagnosed malignancy, ongoing treatment, disease progression or recurrence within six months before admission, or metastatic disease. Multivariate logistic regression analyses were conducted to examine the relationships between SFLs and the CFR with 45-, 90-, and 180-day mortality, adjusting for potential confounders (including serum D-dimer levels). Results Among 92 patients with acute ischemic stroke and active cancer, 38 patients died within 45 days, 56 patients within 90 days, and 67 patients within 180 days after admission. Patients who died had substantially lower SFLs (2.23 vs. 3.44 g/L; p < 0.001; 2.77 vs. 3.44 g/L; p = 0.01; 3.02 vs. 3.11 g/L; p = 0.15) and significantly higher CFR values (17.7 vs. 3.80; p < 0.0001; 14.7 vs. 2.38; p < 0.0001; 13.6 vs. 1.60, p < 0.0001) compared to survivors at each point. After adjusting for confounders, multivariate logistic regression showed that lower SFLs were independently associated with 45-day mortality (odds ratio [OR] = 0.70; 95% confidence interval [CI], 0.49–0.99, p = 0.04), while higher CFR values were associated with increased mortality at 45, 90, and 180-day mortality (OR = 1.06, 1.06, and 1.09; 95% CI = 1.01–1.11, 1.00–1.11, and 1.02–1.17, p = 0.03, 0.04, and 0.02, respectively). Discussion CFR elevation was significantly associated with short-term mortality, and lower SFLs were independently associated with very early (45-day) mortality in patients with acute ischemic stroke and active cancer, regardless of D-dimer levels. These findings indicate that inflammatory and coagulation statuses at stroke onset contribute to short-term outcomes in this patient population.