Risk Score to Predict the Outcome of Patients With Cerebral Vein and Dural Sinus Thrombosis

Cerebrovasc Dis. 2009;28(1):39-44. doi: 10.1159/000215942. Epub 2009 May 6.

Abstract

Background: Around 15% of patients die or become dependent after cerebral vein and dural sinus thrombosis (CVT).

Method: 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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebral Veins*
  • Coma / complications
  • Female
  • Follow-Up Studies
  • Humans
  • International Cooperation
  • Intracranial Hemorrhages / complications
  • Intracranial Thrombosis / complications
  • Intracranial Thrombosis / diagnosis*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models*
  • Prospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • Sex Factors
  • Sinus Thrombosis, Intracranial / complications
  • Sinus Thrombosis, Intracranial / diagnosis*