Mortality in Cerebral Venous Thrombosis: Results from the National Inpatient Sample DatabaseNasr D.M.a · Brinjikji W.b · Cloft H.J.b · Saposnik G.c · Rabinstein A.A.a
Departments of aNeurology and bRadiology, Mayo Clinic, Rochester, Minn., USA; cDepartment of Neurology, University of Toronto, Toronto, Ont., Canada
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Background: Outcomes of cerebral venous thrombosis (CVT) vary from full recovery to death. Few studies have been performed examining epidemiologic and medical risk factors associated with high mortality in CVT. In this study, we examined the National Inpatient Sample (NIS) to determine the epidemiologic and medical risk factors associated with increased mortality from CVT. Materials and Methods: Using the NIS from 2001 to 2008, patients who suffered from CVT were identified using the ICD-9 codes 437.6 (nonpyogenic thrombosis of intracranial venous sinus), 325 (phlebitis and thrombophlebitis of intracranial venous sinuses) and 671.5 (peripartum phlebitis and thrombosis, cerebral venous thrombosis, thrombosis of intracranial venous sinus). We analyzed the associations of demographic factors, risk factors, comorbidities, complications of CVT, and therapeutic interventions with in-hospital mortality. We performed a multivariate logistic regression analysis to determine which variables were independently associated with in-hospital mortality. Results: 11,400 patients were hospitalized with CVT between 2001 and 2008. Two-hundred and thirty-two (2.0%) suffered in-hospital mortality. Patients 15–49 years old had the lowest mortality rate (1.5%) compared with 2.8% for patients aged 50–64 (p < 0.001) and 6.1% for patients ≥65 years old (p < 0.001). The most common condition associated with CVT was pregnancy/puerperium (24.6%), and these women had a low mortality rate (0.4%). On multivariate analysis, the comorbidity most strongly associated with increased risk of mortality was sepsis (mortality rate 15.6%, OR = 7.5, 95% CI = 4.79–11.53, p < 0.001). Malignancy, underlying autoimmune disease and substance abuse were also independently associated with mortality, but with lower mortality rates (<5%). Complications associated with increased risk of mortality included paralysis (8.0%, OR = 3.4, 95% CI = 3.17–6.96, p < 0.001), intracranial hemorrhage (8.7%, OR = 5.4, 95% CI = 4.38–7.96, p < 0.001), and hydrocephalus (15.0%, OR = 3.2, 95% CI = 5.54–15.11, p = 0.004). Demographic variables associated with decreased mortality on multivariate analysis were male gender (2.1%, OR = 0.62, 95% CI = 0.43–0.87, p = 0.006) and Asian/Pacific Islander race (OR = 0.00, 95% CI = 0–0.27, p < 001). Conclusions: CVT is associated with a low in-hospital mortality rate. Amongst patients suffering CVT, male gender and Asian/Pacific Islander race were independently associated with lower odds of in-hospital mortality when compared to their female and white counterparts, respectively. Septic patients with CVT have the greatest risk of in-hospital mortality. Hydrocephalus, intracranial hemorrhage, and motor deficits are also associated with higher risk of death. Our results build on previous evidence that serves to define a group of patients with CVT at high risk of early death.
© 2013 S. Karger AG, Basel
- Bousser MG, Ferro JM: Cerebral venous thrombosis: an update. Lancet Neurol 2007;6:162–170.
- Saposnik G, Barinagarrementeria F, Brown RD, Jr., Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY: Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:1158–1192.
- Stam J: Thrombosis of the cerebral veins and sinuses. New Engl J Med 2005;352:1791–1798.
- Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F: 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.
- Koopman K, Uyttenboogaart M, Vroomen PC, van der Meer J, De Keyser J, Luijckx GJ: Development and validation of a predictive outcome score of cerebral venous thrombosis. J Neurol Sci 2009;276:66–68.
- Ruiz-Sandoval JL, Chiquete E, Banuelos-Becerra LJ, Torres-Anguiano C, Gonzalez-Padilla C, Arauz A, Leon-Jimenez C, Murillo-Bonilla LM, Villarreal-Careaga J, Barinagarrementeria F, Cantu-Brito C: Cerebral venous thrombosis in a Mexican multicenter registry of acute cerebrovascular disease: The RENAMEVASC study. J Stroke Cerebrovasc Dis 2012;21:395–400.
- Ferro JM, Bacelar-Nicolau H, Rodrigues T, Bacelar-Nicolau L, Canhao P, Crassard I, Bousser MG, Dutra AP, Massaro A, Mackowiack-Cordiolani MA, Leys D, Fontes J, Stam J, Barinagarrementeria F: Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis 2009;28:39–44.
- Girot M, Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F, Leys D: Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage. Stroke 2007;38:337–342.
- Khealani BA, Wasay M, Saadah M, Sultana E, Mustafa S, Khan FS, Kamal AK: Cerebral venous thrombosis: a descriptive multicenter study of patients in Pakistan and Middle East. Stroke 2008;39:2707–2711.
- Canhao P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F: Causes and predictors of death in cerebral venous thrombosis. Stroke 2005;36:1720–1725.
- Haghighi AB, Edgell RC, Cruz-Flores S, Feen E, Piriyawat P, Vora N, Callison RC, Alshekhlee A: Mortality of cerebral venous-sinus thrombosis in a large national sample. Stroke 2012;43:262–264.
- Southwick FS, Richardson EP Jr, Swartz MN: Septic thrombosis of the dural venous sinuses. Medicine 1986;65:82–106.
- Coutinho JM, Ferro JM, Canhao P, Barinagarrementeria F, Cantu C, Bousser MG, Stam J: Cerebral venous and sinus thrombosis in women. Stroke 2009;40:2356–2361.
Azin H, Ashjazadeh N: Cerebral venous sinus thrombosis – clinical features, predisposing and prognostic factors. Acta Neurol Taiwan 2008;17:82–87.
- Einhaupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, Masuhr F: EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol 2010;17:1229–1235.
- Hocker SE, Dafer RM, Hacein-Bey L: Successful delayed thrombolysis for cerebral venous and dural sinus thrombosis: a case report and review of the literature. J Stroke Cerebrovasc Dis 2008;17:429–432.
- Ferro JM, Crassard I, Coutinho JM, Canhao P, Barinagarrementeria F, Cucchiara B, Derex L, Lichy C, Masjuan J, Massaro A, Matamala G, Poli S, Saadatnia M, Stolz E, Viana-Baptista M, Stam J, Bousser MG: Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke 2011;42:2825–2831.
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