A total of 170 CVT patients (75 males and 95 females) were recruited with mean age (standard error of mean, SEM) of 35.71 (1.03). Papilledema (55.88%), new-onset epilepsy (32.35%), and decreased LOC (14.12%) occurred most frequently. Among the 170 patients, 95 (55.88%) had three or more sinuses involved and 60 (35.29%) had parenchymal lesions. Detailed data of the reported prognostic markers were presented in Table 1.
Table 1
The detailed data of reported prognostic markers. CNS, central nervous system; CRP, C-reactive protein; CVT, cerebral venous thrombosis; DBP, diastolic blood pressure; LOC, level of consciousness; NLR, neutrophil-to-lymphocyte ratio; NSE, neuron specific enolase; OCPs, oral contraceptive pills.
Prognostic markers | Total (N = 170) | Good outcome (N = 141) | Poor outcome (N = 29) | P |
Age (years) | 35.71 ± 1.03 | 34.73 ± 1.14 | 40.58 ± 2.20 | 0.0331* |
Male, n (%) | 75 (44.12%) | 61 (43.26%) | 14 (48.27%) | 0.6205 |
Decreased LOC, n (%) | 24 (14.12%) | 16 (11.35%) | 8 (27.59%) | 0.0222* |
New-onset epilepsy, n (%) | 55 (32.35%) | 40 (28.39%) | 15 (51.72%) | 0.0143* |
Mental disorders, n (%) | 2 (1.18%) | 1 (0.71%) | 1 (3.45%) | 0.2128 |
Malignancy, n (%) | 2 (1.18%) | 2 (1.42%) | 0 (0.00%) | 0.5188 |
CNS infection, n (%) | 3 (1.76%) | 3 (2.13%) | 0 (0.00%) | 0.4281 |
Deep venous system thrombosis, n (%) | 7 (4.12%) | 6 (4.17%) | 1 (3.45%) | 0.8421 |
Use of OCPs, n (%) | 14 (8.24%) | 10 (7.09%) | 4 (15.38%) | 0.2319 |
DBP (mmHg) | 78.17 ± 0.97 | 77.22 ± 1.09 | 82.21 ± 1.98 | 0.0436* |
Papilledema, n (%) | 95 (55.88%) | 75 (53.19%) | 20 (68.97%) | 0.1192 |
Number of sinuses involved > 3, n (%) | 95 (55.88%) | 82 (58.16%) | 13 (44.83%) | 0.1880 |
Parenchymal lesions, n (%) | 60 (35.29%) | 42 (29.79%) | 18 (62.07%) | 0.0009* |
CRP (mg/L) | 20.58 ± 2.70 | 18.23 ± 2.78 | 31.93 ± 7.96 | 0.0559 |
Fasting blood glucose (mmol/L) | 7.66 ± 2.27 | 8.07 ± 2.73 | 5.64 ± 0.24 | 0.6883 |
NLR | 6.02 ± 1.11 | 4.32 ± 0.59 | 14.05 ± 5.27 | 0.0006* |
NSE (ng/mL) | 16.26 ± 1.18 | 14.24 ± 0.62 | 26.06 ± 5.79 | 0.0001* |
Platelet (109/L) | 256.50 ± 8.91 | 255.50 ± 9.17 | 261.00 ± 28.03 | 0.8191 |
Serum sodium (mmol/L) | 139.60 ± 0.45 | 139.70 ± 0.49 | 139.00 ± 1.20 | 0.5659 |
The patients were subsequently divided into good outcome (n = 129) and poor outcome (n = 26) based on mRS scores at 6 months of follow-up. Age (p = 0.0331), DBP (p = 0.0436), NLR (p = 0.0006), NSE (p = 0.0001), the number of patients with decreased LOC (p = 0.0415), new-onset epilepsy (0.0339), and parenchymal lesions (p = 0.0005) showed significant difference between the patients with good outcome and those with poor outcome (Table 1).
Univariate logistic regression identified age (p = 0.036), decreased LOC (p = 0.048), new-onset epilepsy (p = 0.038), DBP (p = 0.047), parenchymal lesions (p = 0.001), CRP (p = 0.002), NLR (p = 0.012), and NSE (p = 0.008) as significant prognostic markers in Chinese CVT patients (Table 2).
Table 2
Univariate logistic analysis between reported prognostic markers and mRS in Chinese CVT patients. * p < 0.05. CNS, central nervous system; CRP, C-reactive protein; CVT, cerebral venous thrombosis; DBP, diastolic blood pressure; LOC, level of consciousness; NLR, neutrophil-to-lymphocyte ratio; NSE, neuron specific enolase; OCPs, oral contraceptive pills; OR, odds ratio.
Prognostic markers | OR | P |
Age | 1.036 | 0.036* |
Male | 1.117 | 0.797 |
Decreased LOC | 2.800 | 0.048* |
New-onset epilepsy | 2.486 | 0.038* |
Mental disorders | 5.120 | 0.254 |
Malignancy | 0.000 | 0.999 |
CNS infection | 0.000 | 0.999 |
Deep venous system thrombosis | 0.000 | 0.999 |
Use of OCPs | 2.424 | 0.169 |
DBP | 1.043 | 0.047* |
Papilledema | 1.481 | 0.372 |
Number of sinuses involved > 3 | 0.617 | 0.264 |
Parenchymal lesions | 4.523 | 0.001* |
CRP | 4.160 | 0.002* |
Fasting blood glucose | 0.994 | 0.743 |
NLR | 1.149 | 0.012* |
NSE | 1.073 | 0.008* |
Platelet | 1.000 | 0.818 |
Serum sodium | 0.959 | 0.562 |
The cut-off values of age (27.5 years), DBP (79.5 mmHg), CRP (30 mg/L), NLR (6.6) and NSE (16.5 ng/ml) were determined by the maximum value of Youden index (Fig. 1). Using the cut-off values, these continuous variables were converted to binary variables for further multivariate modeling. AUC analysis also showed that age (AUC = 0.6263, p = 0.0426), DBP (AUC = 0.6434, p = 0.0291), NLR (AUC = 0.7667, p = 0.0027), and NSE (AUC = 0.6545, p = 0.0346) independently predicted the clinical outcome of CVT with high sensitivity and specificity. However, the predictive effect of CRP (AUC = 0.5875, p = 0.2441) exhibited low sensitivity and specificity.
A multivariate model including age, decreased LOC, new-onset epilepsy, DBP, parenchymal lesions, CRP, NLR and NSE was conducted (Table 3). Age > 27.5 years (p = 0.036), DBP > 79.5mmHg (p = 0.003), NLR > 6.6 (p < 0.001), and NSE > 16.5 ng/ml (p = 0.015) were identified as significant variables to predict the clinical outcome of Chinese CVT patients.
Table 3
Multivariate logistic analysis between identified prognostic markers and mRS in Chinese CVT patients. * p < 0.05. CVT, cerebral venous thrombosis; DBP, diastolic blood pressure; LOC, level of consciousness; NLR, neutrophil-to-lymphocyte ratio; NSE, neuron specific enolase; OR, odds ratio; SII, Systemic immune-inflammation index.
Prognostic markers | OR | P |
Age > 27.5 years | 6.137 | 0.036* |
Decreased LOC | 1.339 | 0.713 |
New-onset epilepsy | 2.282 | 0.223 |
DBP > 79.5 mmHg | 8.041 | 0.003* |
Parenchymal lesions | 2.105 | 0.315 |
CRP > 30 mg/L | 0.864 | 0.836 |
NLR > 6.6 | 15.578 | 0.000* |
NSE > 16.5 ng/mL | 4.572 | 0.015* |
A CVT outcome score was established using four prognostic markers (age, DBP, NLR, NSE) identified from the multivariate logistic analysis. One point was assigned to NSE > 16.5 ng/ml and age > 27.5 years; two points were assigned to DBP > 79.5mmHg; three points were assigned to NLR > 6.6 (Table 4). A positive correlation between CVT outcome score at baseline and mRS at 6 months of follow-up was observed (p < 0.001, Fig. 2A). ROC analysis showed that CVT outcome score effectively predict the clinical outcome of CVT (AUC = 0.8785, p = 0.0001, Fig. 2B). In addition, the Youden index identified 3.5 as the cutoff value for CVT outcome score. Since CVT outcome score is an integer, patients were divided into CVT outcome score > 3 and ≤ 3. A two-sample t-test showed that the mRS score in patients with CVT outcome score > 3 is significantly lower than those with CVT outcome score ≤ 3 (Fig. 2C).
Table 4
Determination of CVT outcome score for Chinese patients. CVT, cerebral venous thrombosis; DBP, diastolic blood pressure; NLR, neutrophil-to-lymphocyte ratio; NSE, neuron specific enolase.
Prognostic markers | Risk point |
Age | > 27.5 years | 1 |
≤ 27.5 years | 0 |
NSE | > 16.5 ng/mL | 1 |
≤ 16.5 ng/mL | 0 |
DBP | > 79.5 mmHg | 2 |
≤ 79.5 mmHg | 0 |
NLR | > 6.6 | 3 |
≤ 6.6 | 0 |