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Original Paper

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

Ferro J.M.a · Bacelar-Nicolau H.b · Rodrigues T.b · Bacelar-Nicolau L.b · Canhão P.a · Crassard I.d · Bousser M.-G.d · Dutra A.P.f · Massaro A.f · Mackowiack-Cordiolani M.-A.e · Leys D.e · Fontes J.c · Stam J.g · Barinagarrementeria F.h

Author affiliations

aDepartment of Neurosciences (Neurology), Hospital Santa Maria, University of Lisbon, bLaboratory of Biomathematics, Faculdade de Medicina de Lisboa, Lisbon, and cDepartment of Neurology, Hospital de São Marcos, Braga, Portugal; dDepartment of Neurology, Hôpital Lariboisière, Paris, and eDepartment of Neurology, University Hospital, Lille, France; fDepartment of Neurology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil; gDepartment of Neurology, Academic Medical Centre, Amsterdam, The Netherlands; hDepartment of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, Mexico City, Mexico

Related Articles for ""

Cerebrovasc Dis 2009;28:39–44

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: October 31, 2008
Accepted: February 18, 2009
Published online: May 06, 2009
Issue release date: June 2009

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 5

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

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 ≥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.

© 2009 S. Karger AG, Basel


References

  1. Ferro JM, Canhão P, Stam J, Bousser M-G, Barinagarrementeria F; ISCVT Investigators: Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004;35:664–670.
  2. Dentali F, Gianni M, Crowther M, Ageno W: Natural history of cerebral vein thrombosis: a systematic review. Blood 2006;108:1129–1134.
  3. Barinagarrementeria F, Carlos C, Arredondo H: Aseptic cerebral venous thrombosis: proposed prognostic scale. J Stroke Cerebrovasc Dis 1992;2:34–39.
    External Resources
  4. Canhão P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F; ISCVT Investigators: Causes and predictors of death in cerebral venous thrombosis. Stroke 2005;36:1720–1725.
  5. Ferro JM, Lopes MG, Rosas MJ, Ferro MA, Fontes J; Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENOPORT): Long-term prognosis of cerebral vein and dural sinus thrombosis: results of the VENOPORT study. Cerebrovasc Dis 2002;13:272–278.
  6. Bamford JM, Sandercock PA, Warlow C, Slattery J: Interobserver agreement for stroke outcome assessment. Stroke 1989;20:828.
  7. Collett D: Modelling Survival Data in Medical Research. London, Chapman & Hall, 1994, pp 158–162, 169–173.
  8. Katz M: Multivariable Analysis. A Practical Guide for Clinicians. Cambridge, Cambridge University Press, 2006, pp 179–183.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: October 31, 2008
Accepted: February 18, 2009
Published online: May 06, 2009
Issue release date: June 2009

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 5

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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