Information recorded in the DNPR includes admission and discharge dates, and one primary and up to nineteen secondary discharge diagnoses coded according to the International Classification of Diseases (ICD) Tenth Revision since 1994. The DNPR contains data on all inpatient admissions to non-psychiatric hospitals since 1977 and on hospital outpatient and emergency room contacts since 1995. We excluded patients with a history of a cancer diagnosis recorded in the Danish Cancer Registry (DCR). We used the Danish National Patient Registry (DNPR) to identify all patients with a first-time inpatient, outpatient or emergency room diagnosis of syncope. 29, 30 Linkage among databases is possible through a unique ten-digit personal identification number assigned to each Danish resident. 28 Contacts with the healthcare system are recorded in national databases. The Danish national health system provides tax-supported healthcare to all residents of Denmark, ensuring equal access to general practice and hospital care. We conducted a nationwide population-based cohort study in Denmark between 1 January 1994 and 30 November 2013. To study these issues in detail, we examined overall risk of cancer and risk of site-specific cancers in a large cohort of syncope patients, and we compared their cancer risk with that of the general population. Electrolyte imbalance and paraneoplastic phenomena also may induce syncope, as observed in patients with pheochromocytoma, 24 mastocytosis, 25, 26 and carcinoid syndrome. 22, 23 Therefore, it is possible that syncope may be associated with an underlying undiagnosed cancer. 4, 18, 19, 20 Additionally, a recent multicentre study showed that pulmonary embolism was identified in nearly one of every six patients hospitalised for a first episode of syncope, 21 and pulmonary embolism, in turn, is established as a marker for occult cancer. 7, 9, 10, 11, 12, 13, 14, 15, 16 Syncope also can be the first sign of intracranial tumours due to involvement of autonomic cardiovascular control areas. Syncope can occur due to stimulation of the parasympathetic nervous system or carotid sinus by direct neoplastic infiltration. 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Thus, firm epidemiological evidence on the association between syncope and cancer is lacking. 1 Whether syncope may be the presenting sign of an occult cancer is largely unknown. reflex-mediated, orthostatic hypotension or cardiac syncope. 3 Clinically, the condition is categorised on the basis of underlying pathophysiology, i.e. 1 The lifetime cumulative risk of syncope is approximately 35%. 1, 2 Episodes occur frequently, accounting for ~1% of all referrals to emergency departments. Syncope is defined as a sudden loss of consciousness of short duration, with an inability to maintain postural tone, and spontaneous complete recovery. An aggressive search for occult cancer in a patient with syncope is probably not warranted. In short-term the highest cumulative risks were observed for lung, colorectal, prostate and brain cancers. Syncope was a weak marker of an occult cancer. The highest cumulative risks after 6 months of follow-up were lung cancer (0.2%), colorectal cancer (0.2%), prostate cancer (0.1%) and brain cancer (0.1%). The 6-month cumulative risk of any cancer was 1.2%, increasing to 17.9 % for 1–20 years of follow-up. ResultsĪmong 208,361 patients with syncope, 20,278 subsequent cancers were observed. We computed cumulative risks and standardised incidence ratios (SIR) with 95% confidence intervals (CI). Using Danish population-based medical registries, we identified all patients diagnosed with syncope during 1994–2013 and followed them until a cancer diagnosis, emigration, death or end of follow-up, whichever came first. We examined if syncope was a marker of an occult cancer by comparing the risk in patients with a syncope episode with that of the general population.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |