Development and validation of a score for clinical deterioration in patients with cerebral venous thrombosis

Patients with cerebral venous thrombosis (CVT) may experience poor response to anticoagulant therapy and delayed surgical treatment may lead to clinical deterioration. However, the factors contributing to clinical deterioration remain poorly understood. Patients with CVT from three centers between January 2017 and October 2023 were included and grouped as the development cohort and validation cohort. The danger triangle was defined as the posterior two-thirds of the superior sagittal sinus, confluence of sinuses, straight sinus, and deep venous system. The primary endpoint was clinical deterioration, characterized by new or progressive bleeding or infarctions or worsened neurological conditions post-admission. Using the results of multivariable logistic analysis, the Cerebral venOus thrombosis DEterioration (CODE) score was developed within the development cohort and validated within the validation cohort. The score' performance in predicting clinical deterioration was evaluated using the area under the receiver operating characteristic curve (AUC). The development cohort included 194 CVT patients (101 males, and the median age was 38 years). clinical deterioration occurred in 45 (23.2%) patients. Multivariate logistic analysis defined D-dimer > 1.5 mg/L, Glasgow coma scale ≤ 8, intracerebral hemorrhage, danger triangle as risk factors of clinical deterioration. The CODE score integrating these factors performed well to predict patients suffering from clinical deterioration within the validation cohort (n = 79, 11 deteriorations) with an AUC of 0.83 (95%CI, 0.71-0.96) and an accuracy of 88.6% (95%CI, 81.4-95.8%). CODE score could evaluate the risk of clinical deterioration in CVT patients and may serve as a useful tool for decision-making for CVT. Clinical Deterioration in Cerebral Venous Thrombosis: A Predictive Study (CVT deterioration cohort), ClinicalTrials.gov number: NCT06266585, link: https://classic.clinicaltrials.gov/ct2/show/NCT06266585 ).