Natural history of CVST unravelled
MedWire News: Mortality associated with cerebral venous-sinus thrombosis (CVST) is relatively low compared with arterial stroke, US researchers have shown.
Writing in the journal Stroke, they say that prognosis in patients with CVST is largely determined by age, the presence of intracranial hemorrhage, and predisposing conditions.
The study, by Amer Alshekhlee (St Louis University, Missouri) and co-workers, involved a cohort of people diagnosed with CVST from the National Inpatient Sample database between 2000 and 2007.
A total of 3488 patients with CVST were identified. Their mean age was 39.1 years and the vast majority (n=2920) had the pyogenic subtype of CVST.
Women and White patients were predominant in both pyogenic and nonpyogenic subgroups. However, patients with pyogenic CVST were around a decade younger than those with nonpyogenic disease, and had a slightly higher prevalence of predisposing conditions (43.2 vs 38.5%).
Inhospital mortality was 4.39%, report the researchers, and was marginally higher among patients with pyogenic rather than nonpyogenic CVST (4.55 vs 3.52%).
The most common predisposing conditions in both forms of the disease were hematologic disorders and systemic malignancy. Multivariate analysis identified four independent predictors for inhospital mortality in CVST: increasing age, intracranial hemorrhage, respiratory failure, and a severe comorbidity index.
Alshekhlee and co-authors say that their study confirms that mortality in CVST is dependent on the predisposing pathologic processes.
They also note that two of the predisposing conditions associated with high mortality - hematologic disorders and systemic malignancy - can be interrelated "because malignant cells expose tissue factors that promote the coagulation cascade and subsequent thromboembolism."
They add: "In addition to these conditions, age is an important determinant of death in this young cohort."
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By Joanna Lyford