Mirjam R Heldner1, Susanna M Zuurbier2, Bojun Li3, Rascha Von Martial4, Joost C M Meijers5, Rebekka Zimmermann4, Bastian Volbers4, Simon Jung4, Marwan El-Koussy6, Urs Fischer4, Hans P Kohler3, Verena Schroeder3, Jonathan M Coutinho2, Marcel Arnold4. 1. Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland mirjam.heldner@insel.ch. 2. Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. 3. Experimental Haemostasis Group, Department for BioMedical Research, University of Bern, Switzerland. 4. Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland. 5. Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands. 6. Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Switzerland.
Abstract
OBJECTIVE: To investigate prediction of cerebral venous thrombosis (CVT) by clinical variables and D-dimer levels. METHODS: This prospective multicentre study included consecutive patients with clinically possible CVT. On admission, patients underwent clinical examination, blood-sampling for D-dimers-measuring (ELISA-test), and MR-/CT-venography. Predictive value of clinical variables and D-dimers for CVT were calculated. A clinical score to stratify patients into groups with low, moderate, or high CVT risk was established using multivariate logistic regression. RESULTS: CVT was confirmed in 25.8% (94/359) patients by neuroimaging. The optimal estimate of clinical probability was based on 6 variables: seizure(s) at presentation (4 points), known thrombophilia (4 points), oral contraception (2 points), duration of symptoms >6 days (2 points), worst headache ever (1 point) and focal neurological deficit at presentation (1 point) (AUC 0.889).We defined 0-2 points as low CVT probability (NPV 94.1%). 186 (51.8%) patients had a low probability score, of whom 11 (5.9%) had CVT. The frequency of CVT was 28.3% (34/120) in patients with a moderate (3-5 points) and 92.5% (49/53) in patients with a high (6-12 points) probability score. All low CVT probability patients with CVT had D-dimers >500µg/L. Predictive value of D-dimers for CVT for ≥675µg/l (best cut-off) vs. ≥500µg/l respectively was: Sens:77.7%/Spec:77%/NPV:90.7%/ACC:77.2% vs. Sens:89.4%/Spec:66.4%/NPV:94.6%/ACC:72.4%. To the clinical score added D-dimers >500µg/L resulted in the best CVT prediction score explored (at the cut-off≥6 points: Sens:83%/Spec:86.8%/NPV:93.5%/ACC:84.4%/AUC:0.937). CONCLUSION: The proposed new clinical score in combination with D-dimers may be helpful for prediction of CVT as a pretest score;none of the CVT patients showed low clinical probability for CVT and D-dimers <500µg/L.
OBJECTIVE: To investigate prediction of cerebral venous thrombosis (CVT) by clinical variables and D-dimer levels. METHODS: This prospective multicentre study included consecutive patients with clinically possible CVT. On admission, patients underwent clinical examination, blood-sampling for D-dimers-measuring (ELISA-test), and MR-/CT-venography. Predictive value of clinical variables and D-dimers for CVT were calculated. A clinical score to stratify patients into groups with low, moderate, or high CVT risk was established using multivariate logistic regression. RESULTS: CVT was confirmed in 25.8% (94/359) patients by neuroimaging. The optimal estimate of clinical probability was based on 6 variables: seizure(s) at presentation (4 points), known thrombophilia (4 points), oral contraception (2 points), duration of symptoms >6 days (2 points), worst headache ever (1 point) and focal neurological deficit at presentation (1 point) (AUC 0.889).We defined 0-2 points as low CVT probability (NPV 94.1%). 186 (51.8%) patients had a low probability score, of whom 11 (5.9%) had CVT. The frequency of CVT was 28.3% (34/120) in patients with a moderate (3-5 points) and 92.5% (49/53) in patients with a high (6-12 points) probability score. All low CVT probability patients with CVT had D-dimers >500µg/L. Predictive value of D-dimers for CVT for ≥675µg/l (best cut-off) vs. ≥500µg/l respectively was: Sens:77.7%/Spec:77%/NPV:90.7%/ACC:77.2% vs. Sens:89.4%/Spec:66.4%/NPV:94.6%/ACC:72.4%. To the clinical score added D-dimers >500µg/L resulted in the best CVT prediction score explored (at the cut-off≥6 points: Sens:83%/Spec:86.8%/NPV:93.5%/ACC:84.4%/AUC:0.937). CONCLUSION: The proposed new clinical score in combination with D-dimers may be helpful for prediction of CVT as a pretest score;none of the CVT patients showed low clinical probability for CVT and D-dimers <500µg/L.
Authors: Mayte Sánchez van Kammen; Mirjam R Heldner; Justine Brodard; Adrian Scutelnic; Suzanne Silvis; Verena Schroeder; Johanna A Kremer Hovinga; Saskia Middeldorp; Marcel Levi; Sini Hiltunen; Erik Lindgren; Maryam Mansour; Antonio Arauz; Miguel A Barboza; Susanna M Zuurbier; Diana Aguiar de Sousa; Jose M Ferro; Urs Fischer; Thalia S Field; Katarina Jood; Turgut Tatlisumak; Jukka Putaala; Marcel Arnold; Jonathan M Coutinho Journal: JAMA Date: 2021-07-27 Impact factor: 56.272