Prognostic Risk Prediction And Evaluation Of Venous Sinus Thrombosis Patients Based On Venous Compensatory Function

Background and purpose:Cerebral venous sinus thrombosis(CVST)is a cerebrovascular disease characterized by restricted cerebral blood flow which involves the intracranial venous system.Because of its low incidence rate,various causes,diverse clinical manifestations,and certain disability and mortality rates,timely diagnosis and effective treatment in clinical practice have become the key point of clinical research.Some studies have shown that extracranial venous circulation compensation in patients with venous sinus thrombosis is related to the prognosis of CVST patients,but there are only few studies focus on whether to evaluate the prognosis of patients based on venous circulation compensation function.This study aims to quantitatively evaluate extracranial venous compensation in patients with CVST through imaging,and develop a prognostic evaluation scale based on recognized risk factors for CVST,in order to explore the effectiveness of the combination of extracranial venous compensation and clinical related factors in determining prognosis.This is helpful in identifying high-risk factors for poor prognosis,early judging the prognosis of patients,and precising intervention in clinical treatment,we hope to improve the prognosis of patients.Material and Methods:According to strict inclusion and exclusion criteria,40 patients with CVST were collected in the Department of Neurology of the First Affiliated Hospital of Jilin University from June 2021 to December 2022.We collected general information,risk factors,clinical manifestations,laboratory indicators,and imaging data of all patients,extracted extracranial veins using 3D Slicer,and model to obtain their volume.The patients were followed up by telephone 2 months after discharge,and their prognosis was scored using the Modified Rankin Scale(mRS).The prognosis of patients was analyzed by single factor analysis and multiple factor analysis,and a prognostic evaluation scale was developed.The area under curve(AUC)of the receiver operating curve(ROC)were used to evaluate the multifactor model.SPSS25.0 was used for statistical analysis of the data.All statistics were conducted using a bilateral test,and P<0.05 was considered as the difference to be significant.Results:The 40 hospitalized patients with CVST who were included in the study were all followed up.They all had extracranial venous circulation compensation,with an average extracranial venous volume of 4.80±2.39 cm3.There were significant differences between the groups with good and poor prognosis in the presence or absence of consciousness disorders,focal neurological deficits,motor disorders,visual/auditory/language impairments,and other neurological deficits,as well as intracranial hemorrhage,intracranial pressure(ICP)≥300 mmH2O,and compensatory volume of extracranial venous circulation.After multivariate logistic regression,it was found that consciousness impairment(odds ratio(OR)7.256,95%confidence interval(CI)1.319 to 39.925),focal neurological deficits(OR 6.620,95%CI 1.161 to 37.729),intracranial pressure ≥300 mmH2O(OR 8.349,95%CI 1.038 to 67.191),and compensatory volume of extracranial venous circulation(OR 7.008,95%CI 1.005 to 48.858)were independently associated with prognosis.The ROC curve analysis shows that the area under the ROC curve of the model is 0.869,and the 95%confidence interval is(95%CI 0.744 to 0.994,P<0.01),respectively.Considering the feasibility of clinical application,the sensitivity and specificity at the optimal cutoff point are 83%and 79%,respectively,indicating that the model has strong predictive ability.Therefore,patients with a score of 2 or above are considered to have poor prognosis.Conclusions:1.The volume of extracranial veins obtained by modeling the MRV of CVST patients can reflect the compensatory function of extracranial veins,and good compensatory function is beneficial for the prognosis and prognosis of patients.2.Independent risk factors for poor prognosis in CVST patients include consciousness disorders,focal neurological deficits,insufficient compensatory volume of extracranial veins,and intracranial pressure≥300 mmH2O.3.A true and accurate 4-point CVST clinical prognosis assessment scale has been developed based on risk factors including extracranial vein volume,which can serve as one of the application tools for early clinical evaluation of patient prognosis and provide reference for patients’ precise clinical decision-making.