Association of red blood cells, D-dimer, and 13-(S)-HODE with cancer-related ischemic stroke: a case-control study

This study aimed to investigate the clinical characteristics of CRIS and potential laboratory indicators. Acute ischemic stroke (AIS) patients were retrospectively enrolled and categorized into two groups: a cancer-related ischemic stroke (CRIS) group (n = 41) and a non-cancer ischemic stroke group (NC-IS) (n = 213). Baseline characteristics were balanced using 1:1 propensity score matching, adjusting for age, sex, and comorbidities, resulting in 41 patients per group. Serum levels of 13-(S)-hydroxyoctadecadienoic acid [13-(S)-HODE] and nine routine laboratory indicators were measured. Univariate and multivariate logistic regression identified CRIS-associated indicators. Independently associated indicators were evaluated using ROC curve analysis. Additionally, cancer patients without stroke (CNSP, n = 40) and healthy controls (NC, n = 41) were matched to compare routine indicators. Respiratory (34.1%) and digestive (29.3%) cancers were the most common in CRIS patients. Stroke occurred within six months of cancer diagnosis in 36.6% of patients, and 75.6% had multifocal cortical-subcortical infarctions. Multivariate regression confirmed that decreased red blood cells (RBCs) (OR = 0.444, 95% CI: 0.205-0.961), elevated D-dimer (OR = 2.41, 95% CI: 1.67-3.48), and decreased 13-(S)-HODE (OR = 3.20, 95% CI: 1.92-5.33) were independent risk factors for CRIS. The AUCs for the three indicators and the combined model were: RBC, 0.642; D-dimer, 0.739; 13-(S)-HODE, 0.722; combined model, 0.819 (95% CI: 0.729-0.908). CRIS patients had significantly higher D-dimer than CNSP patients (P = 0.001), and lower RBC, lower creatinine, and higher D-dimer than NCs (all P < 0.01). A combined model incorporating decreased RBC, elevated D-dimer, and decreased 13-(S)-HODE demonstrated a significant association with CRIS, showing potential for aiding the distinction of CRIS from NC-IS.