Predictive factors of short-term poor outcome in patients with cerebral venous sinus thrombosis： a reOospective case series study

Abstract

Objective To investigate the predictive factors of short-term poor outcome in patients with cerebral venous sinus thrombosis （CVST）. Methods The clinical data of 42 consecutive inpatients with CVST were analyzed retrospectively. The clinical outcomes were assessed with the modified Rankin scale （mRS） at discharge. The patients were divided into either a good outcome group （mRS 0 to 2） or a poor outcome group （mRS 3 to 6）. The related factors, such as demographic, etiology, and clinical features were compared between the two groups, Multivariate logistic regression analysis was used to determine the independent predictive factors for short-term poor outcome in patients with CVST. Results A total of 42 patients with CVST were enrolled, 29 of them （69.05%） had good outcome and 13 （30. 95%） had poor outcome. The proportions of central nervous system infections （20. 69% vs. 61.54% ;χ2 = 6. 740, P-0. 009）, cancer （6. 90% vs. 38.46% ;χ2= 6. 439, P = 0.011）, pregnancy, postpartum, oral contraceptives or hormone replacement therapy （6. 90% vs. 38.46% ; χ2 = 6. 439, P = 0. 011 ）, and high homocysteine hyperlipidemia （27.59% vs. 76. 92% ;χ2=8. 922, P =0. 003）, as well as the baseline D-dimer levels （730 ± 240 ng/ml vs. 1 060 ± 250 ng/ml; t = 4. 485, P = 0. 000） in patients of the good outcome group were significantly lower than those of the poor outcome group. There was significant difference in treatment modafities 0（2 = 11. 274, P = 0. 004） with the poor outcome group. The proportions of patients in anticoagulants, thrombolysis and anticoagulants ＋ thrombolysis were 13.79%, 24. 14%, and 62.07%, respectively, in the good outcome group, while those were 61.54%, 23.08%, and 15.39%, respectively, in the poor outcome group. Multivariate logistic regression analysis showed that the baseline D-dimer level 〉 990 ng/mL was an independent predictive factor for short-term poor outcome in patients with CVST （odds ratio [ OR] 1.006, 95% confidence interval [ CI] 1.002 - 1.011; P= 0.005）. Anticoagulants ＋ thrombolytic therapy was an independent protective factor for short-term poor outcome in patients with CVST （OR 0. 027, 95% CI 0. 002 - 0. 447; P = 0. 033）. The ROC curve analysis showed that when the cutoff value of the baseline D-dimer was 990 ng/ml, the sensitivity and specificity of predicting short-term poor outcome of CVST were 76. 9% and 86. 2% respectively. Conclusions The level of baseline D-dimer 〉990 ng/ml is an independent predictive factor for short-term poor outcomes in patients with CVST. The effect of anticoagulants in combination with thrombolytic therapy is best in patients with CVST. Key words: Sinus Thrombosis, Intracranial; Prognosis; Risk Factors; Biological Markers; FibrinFibrinogen Degradation Products; Anticoagulants; Thrombolytic Therapy