BACKGROUND Anticoagulation is the mainstay treatment for cerebral venous thrombosis (CVT). A subset of patients might deteriorate despite anticoagulation, and in such cases, endovascular therapy is recommended. METHODS A retrospective review was performed on subjects with CVT from January 2005 to October 2016. The primary outcome was clinical deterioration. Bivariate analysis, multiple logistic regression modeling, and linear discriminant analysis were used to determine a predictive model for deterioration; the results from these models were used to construct a CVT score in order to measure the individual likelihood of deterioration. RESULTS We identified 147 subjects with CVT. The majority were treated with anticoagulation (n = 109, 74.15%); 38 (25.85%) were found to have deterioration, 12 (8.16%) of whom underwent endovascular intervention. The most important risk factors of deterioration, per bivariate analysis, included decreased level of consciousness (odds ratio [OR] = 5.76; 95% confidence interval [CI] 2.59-12.77) and papilledema (OR = 4.52; 95% CI 1.55-13.18). The final multivariable model also included CVT location score (number of sinuses involved), oral contraceptive pill use, sodium level, platelet count, and seizure activity on presentation. This model had a predictive ability to identify deterioration of 83.2%, with a sensitivity of 71.4% and a specificity of 76.2%. Patients with a CVT score of ≥5 have at least 50% chance of deterioration. CONCLUSIONS Decreased mental status, seizure activity, papilledema, number of involved sinuses, as well as sodium level and platelet count are the most important factors in predicting deterioration after CVT. This group may represent a subset of patients in whom early endovascular therapy may be considered.

中文翻译：

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脑静脉血栓形成延迟临床进展的高风险特征：早期干预的建议预测评分。

背景 抗凝是脑静脉血栓形成（CVT）的主要治疗方法。尽管进行了抗凝治疗，一部分患者可能会恶化，在这种情况下，建议进行血管内治疗。方法 对 2005 年 1 月至 2016 年 10 月的 CVT 受试者进行回顾性研究。主要结果是临床恶化。使用双变量分析、多元逻辑回归模型和线性判别分析来确定恶化的预测模型；这些模型的结果用于构建 CVT 评分，以衡量个体恶化的可能性。结果 我们确定了 147 名 CVT 受试者。大多数接受抗凝治疗（n = 109, 74.15%）；38例（25.85%）出现恶化，其中12例（8.16%）接受了血管内介入治疗。根据双变量分析，恶化的最重要风险因素包括意识水平下降（优势比 [OR] = 5.76；95% 置信区间 [CI] 2.59-12.77）和视乳头水肿（OR = 4.52；95% CI 1.55-13.18 ）。最终的多变量模型还包括 CVT 位置评分（涉及的鼻窦数量）、口服避孕药的使用、钠水平、血小板计数和就诊时的癫痫发作活动。该模型对识别恶化的预测能力为 83.2%，敏感性为 71.4%，特异性为 76.2%。CVT 评分≥5 的患者至少有 50% 的机会恶化。结论 精神状态下降、癫痫发作、视乳头水肿、受累鼻窦数量以及钠水平和血小板计数是预测 CVT 后恶化的最重要因素。