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Outcome Prediction in Cerebral Venous Thrombosis: The IN-REvASC Score
Piers Klein1, Liqi Shu2, Thanh N Nguyen1
1Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Insights
A new prognostic score, IN-REvASC, accurately predicts poor neurological outcomes and death in cerebral venous thrombosis (CVT) patients. This score identifies individuals at higher risk, aiding clinical decisions and future trial targeting.
Area of Science:
- Neurology
- Vascular Medicine
- Clinical Epidemiology
Background:
- Cerebral venous thrombosis (CVT) poses significant risks for poor neurological outcomes and mortality.
- Accurate prognostication is crucial for effective patient management and clinical trial design in CVT.
Purpose of the Study:
- To identify risk factors for poor neurological outcome and death in patients with cerebral venous thrombosis (CVT).
- To derive and validate a novel prognostic score for predicting outcomes in CVT.
- To compare the performance of the new score against existing scores.
Main Methods:
- An international multicenter retrospective study involving 1,025 consecutive CVT patients (January 2015 - December 2020).
- Collection of demographic, clinical, and radiographic data.
- Multivariable logistic regression analysis to identify risk factors for poor outcome (modified Rankin Scale 3-6 at 90 days).
- Derivation and validation of the IN-REvASC prognostic score.
Main Results:
- Seven factors significantly associated with poor 90-day outcome included active cancer, age, Black race, encephalopathy/coma, decreased hemoglobin, higher NIHSS score, and substance use.
- The IN-REvASC score demonstrated superior predictive accuracy for poor outcome (AUC 0.84) compared to ISCVT-RS (AUC 0.71).
- The IN-REvASC score also showed improved prediction of mortality (AUC 0.84) versus ISCVT-RS (AUC 0.72).
Conclusions:
- Active cancer, age, Black race, encephalopathy/coma, decreased hemoglobin, higher NIHSS, and substance use are key predictors of poor neurological outcome in CVT.
- The IN-REvASC score significantly enhances prognostic accuracy for poor outcomes and mortality in CVT patients compared to the ISCVT-RS.
- The IN-REvASC score can aid clinical decision-making and identify high-risk CVT patients for targeted therapies in future research.
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.
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