Study On The Correlation Between PLR,LMR,D-dimer And The Prognosis Of Patients With Cerebral Venous Sinus Thrombosis

Background Cerebral Venous Sinus Thrombosis(CVST)is a special and rare type of cerebrovascular disease characterized by cerebral venous return obstruction or venous ischemia and cerebrospinal fluid absorption disorder caused by various reasons,accounting for 0.5–1% of all strokes,can range from 1% to 2% in adult stroke.Studies have shown that the peak incidence of adults is 20-30 years old,the ratio of male to female is 1:1.5-5 per year,and the annual incidence is about 1.5~2.5/1 million.Currently,the study suggests that factors associated with poor CVST outcomes include stage,age,gender,cancer,cerebral hemorrhage,and deep vein involvement.Currently,in the prognosis-related study of CVST patients,the prognostic scale derived from the large-scale international multi-center observational study is currently recognized as an epidemiological tool about the prognosis of CVST.The etiologies of CVST are diverse,and it is related to hemodynamic abnormalities,abnormal blood vessel wall and hypercoagulability.It is mainly divided into two categories: infectious and non-infectious.The mechanism of inflammation plays an important role in the development of CVST.D-dimer,platelet to lymphocyte ratio(PLR)and lymphocyte to monocyte ratio(LMR)have been reported to be an effective prognostic determinant in various entities such as neurology,cervical vascular surgery,major vascular surgery,cardiology and surgery,and oncology.In particular,PLR and LMR have become hotspots in recent years.However,there are few reports on the application of cerebral venous sinus thrombosis.Purpose This study aimed to provide a preliminary analysis of the distribution of factors in patients with cerebral venous sinus thrombosis through a single-center retrospective study.Patient Selection and methods 1.Subjects 228 patients with cerebral venous sinus thrombosis who were hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2016 were selected.In line with the database standard,all patients enrolled in the relevant tests and signed the database to include informed consent.The diagnosis of CVST is judged by two neurologists together with the imaging doctor.If the case is suspected or cannot be clearly diagnosed,it is directly removed.2.Data collection Recording demographic characteristics and clinical data,including inducement,age,gender,symptoms,laboratory indicators(including three types of factor D-dimer,platelet to lymphocyte ratio,lymphocyte to monocyte ratio),imaging characteristics,etc.3.Outcomes Prognostic evaluation was conducted by telephone follow-up after professional training by a dedicated follow-up physician.Using the modified Rankin Scale(m RS),m RS ? 2 was defined as a good neurological prognosis,and the m RS score of 3-6 was defined as a poor neurological prognosis.The overall survival time is defined as the time from admission to death due to intracranial venous sinus thrombosis,or the last follow-up time.4.Statistical analysis All statistical analyses were performed using SPSS 19.0 software.Continuous variables that conformed to the normal distribution were expressed as mean ± standard deviation.Student t-test was done to determine difference among continuous variables.When the normal distribution was not satisfied,the median was used for comparison;Categorical variables were expressed in terms of counts and percentages [n(%)],using chi-square test or Fisher analysis.Kaplan-Meier survival analysis was used to compare the survival of CVST patients,and the Log-Rank method was used for testing.The area under the curve(AUC)of the receiver operating characteristic curve(ROC)was calculated to evaluate the accuracy of the predicted values of the three types of factors.Multivariate Cox regression was used to analyze independent factors affecting patient outcomes.All the statistics were tested by two-sided test,and P < 0.05 was considered to be significant.Results 1.There were 263 patients with confirmed CVST admitted during the study period.We excluded 5 patients who were younger than 18 years old,10 patients who were lost to follow-up and 20 patients because of incomplete clinical data.A total of 228 CVST patients were enrolled into this study.The average follow-up period was 22 months(6-66 months).Among them,187 patients(82.0%)had a good outcome,41 patients(18.0%)had a poor outcome and 30 patients died(13.2%).2.The results of Cox survival analysis were that PLR(HR=1.007,95%CI: 1.003-1.011,P =0.001)was independently associated with poor prognosis.Compared with LMR and D-dimer,the model with PLR was more accurate.The curve of AUC is 0.726(95% CI 0.634-0.817,P <0.01)and the optimal cut-off point is 168.3.The sensitivity of predicting CVST prognosis was 78.0% and specificity was 65.2%.At the optimal cut-off point,specificity and sensitivity have reference significance.Conclusion PLR is an independent risk factor for survival prognosis in patients with CVST;LMR may be an independent risk factor for survival prognosis of patients with CVST; D-dimer is not an independent risk factor in patient with CVST.