A Practical Score for Prediction of Outcome After Cerebral Venous Thrombosis.

Miguel A Barboza,Fernando Barinagarrementería,Antonio Arauz,Marlon Merlos-Benitez,Erwin Chiquete,Alejandro Quiroz-Compeán,Carlos Cantú-Brito

doi:10.3389/fneur.2018.00882

Abstract

Background: Most patients with cerebral venous thrombosis (CVT) have independent survival in the short term. However, identification of high-risk individuals with an unfavorable outcome is a challenging task. We aimed to develop a CVT grading scale (CVT-GS) to aid in the short-term clinical decision-making.Methods: We included 467 consecutive patients with CVT who were hospitalized from 1981 to 2015 in two third-level referral hospitals. Factors associated with 30-day mortality were selected with bivariate analyses to integrate a Cox proportional-hazards model to determine components of the final scoring. After the scale was configured, the prognostic performance was tested for prediction of short-term death or moderately impaired to death [modified Rankin scale (mRS) > 2]. CVT-GS was categorized as mild, moderate or severe for the prediction of 30-day fatality rate and a probability of mRS > 2.Results: The 30-day case fatality rate was 9.0%. The CVT-GS (0–13 points; more points predicting poorer outcomes) was composed of parenchymal lesion size > 6 cm (3 points), bilateral Babinski signs (3 points), male sex (2 points), parenchymal hemorrhage (2 points), and level of consciousness (coma: 3 points, stupor: 2, somnolence: 1, and alert: 0). CVT was categorized as mild (0–2 points, 0.4% fatality rate), moderate (3–7 points, 9.9% fatality rate), or severe (8–13 points, 61.4% fatality rate). The CVT-GS had an accuracy of 91.6% for the prediction of 30-day mortality and 85.3% for mRS > 2.Conclusions: CVT-GS is a practical clinical tool for prediction of outcome after CVT. This score may aid in clinical decision-making and could serve to stratify patients enrolled in clinical trials.

Highlights

Cerebral venous thrombosis (CVT) is an uncommon cause of cerebrovascular disease accounting for < 1% of all acute strokes [1,2,3]
We excluded patients with unconfirmed diagnosis of CVT on imaging tests and records with incomplete clinical information and functional status at 30 days of follow up, CVT cases associated with central nervous system infections, or parameningeal infections
Lesion size in venous/hemorrhagic infarction or focal edema is not clearly established in previous CVT articles, we developed a direct measurement of the highest diameter of the venous infarction or hemorrhage, traced on the brain computed tomography (CT) or magnetic resonance (MR) on the slice with the highest area of parenchymal lesion, and the subscale system was established according to the performance from all the diameter sizes in a receiver operating characteristic curve (ROC) for the composite of death and bad functional outcome

Summary

Introduction

Cerebral venous thrombosis (CVT) is an uncommon cause of cerebrovascular disease accounting for < 1% of all acute strokes [1,2,3]. With > 80% of patients attaining short-term independent survival [1, 4]. Despite the highly favorable prognosis, identification of CVT patients with a possible unfavorable outcome can be challenging. Based on hospital registries, there are some inconsistencies in the distribution of CVT causes, identified risk factors and outcome rates. Most patients with cerebral venous thrombosis (CVT) have independent survival in the short term. Identification of high-risk individuals with an unfavorable outcome is a challenging task. We aimed to develop a CVT grading scale (CVT-GS) to aid in the short-term clinical decision-making

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