Lung Cancer Increases Risk of Acute Ischemic Stroke and Complications During Hospitalization

Background and Objectives Lung cancer (LC) imposes a significant global health burden as the leading cause of cancer‐related death. The presence of lung cancer more than doubles patients’ risk of acute ischemic stroke (AIS) throughmultiple pathophysiological mechanisms. We will leverage the National Inpatient Sample (NIS) databaseto perform a retrospective cross‐sectional analysis comparing comorbidity profiles, complication rates,and in‐hospital outcomes of patients with and without comorbid lung cancer hospitalized for AIS. Methods A retrospective cross‐sectional analysis was conducted using data from the NIS between 2015 and 2021.This nationally representative sample included adult patients (≥18 years old) in the United Stateshospitalized primarily for acute ischemic strokes. Patients were stratified into two groups: one with aconcurrent diagnosis of lung cancer and one without. Outcomes included odds of inpatient mortality,routine discharge, complications, comorbidities, and receipt of reperfusion therapy. Propensityscore‐based inverse probability of treatment weighting (IPTW) adjusted for confounding factors.Multivariable logistic regression evaluated adjusted odds ratios (aORs) and 95% confidence intervals(CIs) for all outcomes. Results Among 1,358,155 AIS hospitalizations, 11,755 (0.86%) had LC. Following inverse probability weighting,the LC‐AIS group had significantly increased odds of inpatient mortality (aOR:2.81, 95% CI[2.37‐3.33],p<0.001). LC‐AIS was significantly less likely to receive intravenous thrombolysis(0.45[0.39–0.52],p<0.001) but did not have a statistically significant difference in odds of endovascularthrombectomy (1.02[0.87–1.19],p=0.809). LC‐AIS was associated with significantly increased odds ofpneumonia (3.42[2.86–4.08],p<0.001), deep vein thrombosis (4.46[3.54–5.61], p<0.001), pulmonaryembolism (5.57 [4.45–6.98],p<0.001), cerebral edema and herniation(1.61[1.37–1.91], p<0.001),hemorrhagic transformation (1.23[1.03–1.47],p=0.022), acute respiratory distress syndrome(2.46[1.29–4.70],p=0.006), sepsis (1.41[1.06–1.88],p=0.019), and acute myocardial infarction(2.52[1.99–3.17],p<0.001) Conclusion These findings suggest that inpatient LC‐AIS mortality and morbidity occur through distinctpathophysiological mechanisms. Patients with lung cancer and AIS potentially require differentdiagnostic and therapeutic strategies than those typically provided in standard AIS care, such as earlyvenous thromboembolism prophylaxis, aggressive respiratory monitoring, and multidisciplinarymanagement.