新型临床评分与 D-二聚体水平联合预测脑静脉血栓形成。
Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels.
机构信息
From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
出版信息
Neurology. 2020 Aug 18;95(7):e898-e909. doi: 10.1212/WNL.0000000000009998. Epub 2020 Jun 23.
OBJECTIVE
To investigate prediction of cerebral venous thrombosis (CVT) by clinical variables and D-dimer levels.
METHODS
This prospective multicenter study included consecutive patients with clinically possible CVT. On admission, patients underwent clinical examination, blood sampling for D-dimers measuring (ELISA test), and magnetic resonance/CT venography. Predictive value of clinical variables and D-dimers for CVT was calculated. A clinical score to stratify patients into groups with low, moderate, or high CVT risk was established with multivariate logistic regression.
RESULTS
CVT was confirmed in 26.2% (94 of 359) of 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 neurologic deficit at presentation (1 point) (area under the curve [AUC] 0.889). We defined 0 to 2 points as low CVT probability (negative predictive value [NPV] 94.1%). Of the 186 (51.8%) patients who had a low probability score, 11 (5.9%) had CVT. The frequency of CVT was 28.3% (34 of 120) in patients with a moderate (3-5 points) and 92.5% (49 of 53) in patients with a high (6-12 points) probability score. All low CVT probability patients with CVT had D-dimers >500 μg/L. Predictive value of D-dimers for CVT for >675 μg/L (best cutoff) vs >500 μg/L was as follows: sensitivity 77.7%, specificity, 77%, NPV 90.7%, and accuracy 77.2% vs sensitivity 89.4%, specificity 66.4%, NPV 94.6%, and accuracy 72.4%, respectively. Adding the clinical score to D-dimers >500 μg/L resulted in the best CVT prediction score explored (at the cutoff ≥6 points: sensitivity 83%/specificity 86.8%/NPV 93.5%/accuracy 84.4%/AUC 0.937).
CONCLUSION
The proposed new clinical score in combination with D-dimers may be helpful for predicting CVT as a pretest score; none of the patients with CVT showed low clinical probability for CVT and D-dimers <500 μg/L.
CLINICALTRIALSGOV IDENTIFIER
NCT00924859.
目的
探讨临床变量和 D-二聚体水平对脑静脉血栓形成（CVT）的预测作用。
方法
本前瞻性多中心研究纳入了临床疑似 CVT 的连续患者。入院时，患者接受临床检查、D-二聚体检测（ELISA 法）和磁共振/CT 静脉造影。计算临床变量和 D-二聚体对 CVT 的预测价值。采用多变量逻辑回归建立了一种临床评分，用于将患者分为低、中、高 CVT 风险组。
结果
神经影像学证实 CVT 占 26.2%（359 例中的 94 例）。最佳临床概率估计基于 6 个变量：发作时（4 分）、已知的易栓症（4 分）、口服避孕药（2 分）、症状持续时间>6 天（2 分）、最剧烈的头痛（1 分）和发作时局灶性神经功能缺损（1 分）（曲线下面积[AUC]0.889）。我们将 0-2 分定义为低 CVT 概率（阴性预测值[NPV]94.1%）。在 186 例（51.8%）低概率评分患者中，有 11 例（5.9%）患有 CVT。中度（3-5 分）患者的 CVT 发生率为 28.3%（34/120），高度（6-12 分）患者的 CVT 发生率为 92.5%（49/53）。所有低 CVT 概率患者的 D-二聚体>500μg/L。对于>675μg/L（最佳截断值）与>500μg/L 的 D-二聚体，CVT 的预测价值如下：敏感性 77.7%，特异性 77%，NPV 90.7%，准确性 77.2%与敏感性 89.4%，特异性 66.4%，NPV 94.6%和准确性 72.4%，分别。将临床评分与 D-二聚体>500μg/L 相结合，可以得到最佳的 CVT 预测评分（截断值≥6 分：敏感性 83%/特异性 86.8%/NPV 93.5%/准确性 84.4%/AUC0.937）。
结论
该研究提出的新的临床评分与 D-二聚体联合使用可能有助于作为一种预测 CVT 的预测试评分；没有 CVT 患者的 CVT 临床概率低且 D-二聚体<500μg/L。
临床试验注册号
NCT00924859。
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