A scoring tool to predict mortality and dependency after cerebral venous thrombosis
Erik Lindgren, Katarzyna Krzywicka, Maria A. de Winter, Mayte Sánchez van Kammen, Mirjam R. Heldner, Sini Hiltunen, Diana Aguiar de Sousa, Maryam Mansour, Patrícia Canhão, Esme Ekizoğlu, Miguel Rodrigues, Elisa Silva, Carlos García-Esperón, Valentina Arnao, Paolo Aridon, Naaem Simaan, Suzanne M. Silvis, Susanna M. Zuurbier, Adrian Scutelnic, Mine Sezgin, А. М. Алашеев, Andrey Smolkin, Daniel Guisado‐Alonso, Nilüfer Yeşilot, Miguel A. Barboza, Masoud Ghiasian, Ronen R. Leker, Antonio Araúz, Marcel Arnold, Jukka Putaala, Turgut Tatlisumak, Jonathan M. Coutinho, Katarina Jood
Abstract
Abstract Background and purpose A prognostic score was developed to predict dependency and death after cerebral venous thrombosis (CVT) to identify patients for targeted therapy in future clinical trials. Methods Data from the International CVT Consortium were used. Patients with pre‐existent functional dependency were excluded. Logistic regression was used to predict poor outcome (modified Rankin Scale score 3–6) at 6 months and Cox regression to predict 30‐day and 1‐year all‐cause mortality. Potential predictors derived from previous studies were selected with backward stepwise selection. Coefficients were shrunk using ridge regression to adjust for optimism in internal validation. Results Of 1454 patients with CVT, the cumulative number of deaths was 44 (3%) and 70 (5%) for 30 days and 1 year, respectively. Of 1126 patients evaluated regarding functional outcome, 137 (12%) were dependent or dead at 6 months. From the retained predictors for both models, the SI 2 NCAL 2 C score was derived utilizing the following components: absence of female‐sex‐specific risk factor, intracerebral hemorrhage, infection of the central nervous system, neurological focal deficits, coma, age, lower level of hemoglobin (g/l), higher level of glucose (mmol/l) at admission, and cancer. C‐statistics were 0.80 (95% confidence interval [CI] 0.75–0.84), 0.84 (95% CI 0.80–0.88) and 0.84 (95% CI 0.80–0.88) for the poor outcome, 30‐day and 1‐year mortality model, respectively. Calibration plots indicated a good model fit between predicted and observed values. The SI 2 NCAL 2 C score calculator is freely available at www.cerebralvenousthrombosis.com . Conclusions The SI 2 NCAL 2 C score shows adequate performance for estimating individual risk of mortality and dependency after CVT but external validation of the score is warranted.