Abstract
Among cerebral venous thrombosis (CVT) patients, those with venous infarction have more severe clinical presentations and worse outcomes. Identifying biomarkers associated with venous infarction in CVT may help understand the pathogenesis and provide potentially useful therapeutic markers. Fifty-two CVT patients were prospectively recruited and divided into three groups: acute/subacute CVT with venous infarction (ASVI, n=30), without venous infarction (ASOVI, n=13), and chronic CVT (n=9). Blood brain barrier (BBB) permeability-related proteins, including claudin-5, occludin, matrix metalloproteinase-9, glial fibrillary acidic protein, and S100B, and inflammation-related factor high-sensitivity C-reactive protein (hs-CRP), were tested in serum and/or cerebrospinal fluid upon admission. We compared these biomarkers between the three groups and investigated their associations with venous infarction and clinical symptom severity in acute/subacute CVT patients on admission using the NIH Stroke Scale (NIHSS). Serum hs-CRP was significantly higher in acute/subacute CVT patients than chronic CVT patients. For acute/subacute CVT patients, levels were significantly higher in the ASVI group than the ASOVI group for serum claudin-5 (medians 2.80 vs. 2.50 mg/I, respectively, P = 0.039) and hs-CRP (medians 17.25 vs. 2.27 mg/l, respectively, P = 0.003). Both these biomarkers, analyzed as categorical or continuous variables, were also significantly associated with venous infarction in acute/subacute CVT patients after logistic regression analysis. Additionally, hs-CRP was positively correlated with the NIHSS (r = 0.710, P < 0.001) on admission in acute/subacute CVT patients. In CVT patients, venous infarction was associated with BBB disruption and potentially inflammation. Hs-CRP might serve as a biomarker reflecting the clinical severity of CVT in the acute/subacute stages.
Highlights
Studies using conventional or novel imaging methods have suggested that cerebral venous infarction is not uncommon; it occurs in approximately 60% of patients with cerebral venous thrombosis (CVT) [1,2,3]
There was no significant difference in baseline characteristics between the acute/subacute CVT with venous infarction (ASVI) and acute/subacute CVT without venous infarction (ASOVI) patients, or between the three groups, except that the NIH Stroke Scale (NIHSS) score was significantly higher in the ASVI group than in the ASOVI and chronic
We found that serum High-sensitivity C-reactive protein (CRP) (hs-CRP) was significantly associated with venous infarction in acute/subacute CVT patients
Summary
Studies using conventional or novel imaging methods have suggested that cerebral venous infarction is not uncommon; it occurs in approximately 60% of patients with cerebral venous thrombosis (CVT) [1,2,3]. In acute/subacute CVT patients, the presence of venous infarction is associated with more severe clinical presentations and worse outcomes [4,5]. Identifying biomarkers associated with venous infarction and clinical severity in CVT patients may help in understanding the ISSN: 2152-5250. Our latest research suggested that inflammation might develop after CVT and is significantly correlated with the severity of clinical symptoms on admission and poor outcomes at discharge [17]. A recent study reported that C-reactive protein (CRP), a marker of acute inflammation, had predictive value for venous thromboembolism [18]. An experimental study has revealed that CVT-induced BBB disruption and venous infarction may depend on inflammatory cell recruitment [20]. The proteins related to BBB permeability and inflammation may be elevated in the serum and/or cerebrospinal fluid (CSF) in CVT patients with venous infarction. Inflammation may play an important role in determining the severity of clinical symptoms
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