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.

Keywords:
Dural sinus, Cerebral vein thrombosis, Outcome, Validation, Risk score
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.
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.
© 2009 S. Karger AG, Basel
2009
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