Prognosis of cerebral vein and dural sinus thrombosis - Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)
Prognosis of cerebral vein and dural sinus thrombosis - Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)
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DOI：
10.1161/01.str.0000117571.76197.26
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发表时间：
2004-03-01
期刊：
影响因子：
8.3
通讯作者：
Barinagarrementeria, F
中科院分区：
文献类型：
--
作者：
Ferro, JM;Canhao, P;Barinagarrementeria, F
背景和目的--脑静脉和硬脑膜窦血栓形成(CVT)的自然病史和长期预后以前没有足够的前瞻性研究。方法：我们进行了一项多国(21个国家)、多中心(中心)的前瞻性观察研究。术后6个月及以后每年进行随访。结果：从1998年5月到2001年5月，共登记了624名成年CVT患者。随访结束时(中位16个月)，356例(57.1%)患者无症状或体征(MRS=0)，137例(22%)有轻微残留症状(MRS=1)，47例(7.5%)有轻度损害(MRS=2)。18例(2.9%)为中度损伤(MRS=3)，14例(2.2%)为重度残疾(MRS=4或5)，52例(8.3%)死亡。死亡或依赖的多因素预测因素为年龄和年龄；37岁(危险比[HR]=2.0)、男性(HR=1.6)、昏迷(HR=2.7)、精神状态障碍(HR=2.0)、入院时出血(HR=1.9)、大脑深静脉系统血栓形成(HR=2.9)、中枢神经系统感染(HR=3.3)和癌症(HR=2.9)。14例(2.2%)再发静脉窦血栓，27例(4.3%)有其他血栓事件，66例(10.6%)有癫痫发作。临床可识别的CVT患者中的一个亚组(13%)具有更高的不良结局风险。这些高危患者可能会从更积极的治疗干预中受益，这将在随机临床试验中进行研究。
Background and Purpose - The natural history and long-term prognosis of cerebral vein and dural sinus thrombosis (CVT) have not been examined previously by adequately powered prospective studies.Methods - We performed a multinational ( 21 countries), multicenter ( 89 centers), prospective observational study. Patients were followed up at 6 months and yearly thereafter. Primary outcome was death or dependence as assessed by modified Rankin Scale ( mRS) score > 2 at the end of follow-up.Results - From May 1998 to May 2001, 624 adult patients with CVT were registered. At the end of follow-up ( median 16 months), 356 patients (57.1%) had no symptom or signs ( mRS = 0), 137 (22%) had minor residual symptoms ( mRS = 1), and 47 (7.5%) had mild impairments ( mRS = 2). Eighteen (2.9%) were moderately impaired ( mRS = 3), 14 (2.2%) were severely handicapped ( mRS = 4 or 5), and 52 (8.3%) had died. Multivariate predictors of death or dependence were age > 37 years ( hazard ratio [HR] = 2.0), male sex ( HR = 1.6), coma ( HR = 2.7), mental status disorder ( HR = 2.0), hemorrhage on admission CT scan ( HR = 1.9), thrombosis of the deep cerebral venous system ( HR = 2.9), central nervous system infection ( HR = 3.3), and cancer ( HR = 2.9). Fourteen patients ( 2.2%) had a recurrent sinus thrombosis, 27 (4.3%) had other thrombotic events, and 66 (10.6%) had seizures.Conclusions - The prognosis of CVT is better than reported previously. A subgroup (13%) of clinically identifiable CVT patients is at increased risk of bad outcome. These high-risk patients may benefit from more aggressive therapeutic interventions, to be studied in randomized clinical trials.