Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis.
BACKGROUND
Around 15% of patients die or become dependent after cerebral vein and dural sinus thrombosis (CVT).


METHODS
We used the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) sample (624 patients, with a median follow-up time of 478 days) to develop a Cox proportional hazards regression model to predict outcome, dichotomised by a modified Rankin Scale score >2. From the model hazard ratios, a risk score was derived and a cut-off point selected. The model and the score were tested in 2 validation samples: (1) the prospective Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENOPORT) sample with 91 patients; (2) a sample of 169 consecutive CVT patients admitted to 5 ISCVT centres after the end of the ISCVT recruitment period. Sensitivity, specificity, c statistics and overall efficiency to predict outcome at 6 months were calculated.


RESULTS
The model (hazard ratios: malignancy 4.53; coma 4.19; thrombosis of the deep venous system 3.03; mental status disturbance 2.18; male gender 1.60; intracranial haemorrhage 1.42) had overall efficiencies of 85.1, 84.4 and 90.0%, in the derivation sample and validation samples 1 and 2, respectively. Using the risk score (range from 0 to 9) with a cut-off of >or=3 points, overall efficiency was 85.4, 84.4 and 90.1% in the derivation sample and validation samples 1 and 2, respectively. Sensitivity and specificity in the combined samples were 96.1 and 13.6%, respectively.


CONCLUSIONS
The CVT risk score has a good estimated overall rate of correct classifications in both validation samples, but its specificity is low. It can be used to avoid unnecessary or dangerous interventions in low-risk patients, and may help to identify high-risk CVT patients.
Ferro
José M
JM
Department of Neurosciences-Neurology, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal. jmferro@fm.ul.pt
Bacelar-Nicolau
Helena
H
Rodrigues
Teresa
T
Bacelar-Nicolau
Leonor
L
Canhão
Patrícia
P
Crassard
Isabelle
I
Bousser
Marie-Germaine
MG
Dutra
Aurélio Pimenta
AP
Massaro
Ayrton
A
Mackowiack-Cordiolani
Marie-Anne
MA
Leys
Didier
D
Fontes
João
J
Stam
Jan
J
Barinagarrementeria
Fernando
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002550:Cerebral Veins; D003128:Coma / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D020300:Intracranial Hemorrhages / Q000150:complications; D020767:Intracranial Thrombosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000175:diagnosis*