J Stroke.  2022 Sep;24(3):404-416. 10.5853/jos.2022.01606.

Outcome Prediction in Cerebral Venous Thrombosis: The IN-REvASC Score

• Klein P
• Shu L
• Nguyen TN
• Siegler JE
• Omran SS
• Simpkins AN
• Heldner M
• Havenon Ad
• Aparicio HJ
• Abdalkader M
• Psychogios M
• Vedovati MC
• Paciaroni M
• Martial Rv
• Liebeskind DS
• Sousa DAd
• Coutinho JM
• Yaghi S
• the ACTION-CVT Study Group

• KMID: 2534270
• DOI: http://doi.org/10.5853/jos.2022.01606

Abstract

Background
We identified risk factors, derived and validated a prognostic score for poor neurological outcome and death for use in cerebral venous thrombosis (CVT). Methods We performed an international multicenter retrospective study including consecutive patients with CVT from January 2015 to December 2020. Demographic, clinical, and radiographic characteristics were collected. Univariable and multivariable logistic regressions were conducted to determine risk factors for poor outcome, mRS 3-6. A prognostic score was derived and validated. Results A total of 1,025 patients were analyzed with median 375 days (interquartile range [IQR], 180 to 747) of follow-up. The median age was 44 (IQR, 32 to 58) and 62.7% were female. Multivariable analysis revealed the following factors were associated with poor outcome at 90- day follow-up: active cancer (odds ratio [OR], 11.20; 95% confidence interval [CI], 4.62 to 27.14; P<0.001), age (OR, 1.02 per year; 95% CI, 1.00 to 1.04; P=0.039), Black race (OR, 2.17; 95% CI, 1.10 to 4.27; P=0.025), encephalopathy or coma on presentation (OR, 2.71; 95% CI, 1.39 to 5.30; P=0.004), decreased hemoglobin (OR, 1.16 per g/dL; 95% CI, 1.03 to 1.31; P=0.014), higher NIHSS on presentation (OR, 1.07 per point; 95% CI, 1.02 to 1.11; P=0.002), and substance use (OR, 2.34; 95% CI, 1.16 to 4.71; P=0.017). The derived IN-REvASC score outperformed ISCVT-RS for the prediction of poor outcome at 90-day follow-up (area under the curve [AUC], 0.84 [95% CI, 0.79 to 0.87] vs. AUC, 0.71 [95% CI, 0.66 to 0.76], χ2 P<0.001) and mortality (AUC, 0.84 [95% CI, 0.78 to 0.90] vs. AUC, 0.72 [95% CI, 0.66 to 0.79], χ2 P=0.03). Conclusions Seven factors were associated with poor neurological outcome following CVT. The INREvASC score increased prognostic accuracy compared to ISCVT-RS. Determining patients at highest risk of poor outcome in CVT could help in clinical decision making and identify patients for targeted therapy in future clinical trials.

Keyword

Stroke; Sinus thrombosis, intracranial; Prognosis

Figure

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  Figure 1. Prognostic models for poor outcome at 90-day follow-up. AUC, area under the curve; ISCVT-RS, International Study on Cerebral Vein and Dural Sinus Thrombosis risk score.

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  Figure 2. Study flow chart. ACTION-CVT, Anticoagulation in the Treatment of Cerebral Venous Thrombosis; mRS, modified Rankin Scale.

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  Figure 3. Distribution of scores on the modified Rankin Scale (mRS) at 90 days according to IN-REvASC risk groups.

Reference

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