Blood biomarkers associated with inflammation predict poor prognosis in cerebral venous thrombosis:

Abstract

Background and purpose: Experimental studies suggest inflammation can contribute to blood barrier disruption and brain injury in cerebral venous thrombosis (CVT). We aimed to determine whether blood biomarkers of inflammation were associated with the evolution of brain lesions, persistent venous occlusion or functional outcome in patients with CVT. Methods: Pathophysiology of Venous Infarction-Prediction of Infarction and Recanalization in CVT (PRIORITy-CVT) was a multicenter prospective cohort study of patients with newly diagnosed CVT. Evaluation of neutrophilto-lymphocyte ratio (NLR) and C-reactive protein (CRP) concentrations in peripheral blood samples was performed at admission in 62 patients. Additional quantification of interleukin (IL)-6 was performed at day 1, 3 and 8 in 35 patients and 22 healthy controls. Standardized magnetic resonance imaging was performed at day 1, 8 and 90. Primary outcomes were early evolution of brain lesion, early recanalization and functional outcome at 90 days. Results: Interleukin-6 levels were increased in patients with CVT with a peak at baseline. IL-6, NLR and CRP levels were not related with brain lesion outcomes or early recanalization but had a significant association with unfavourable functional outcome at 90 days

Acute Inflammation in Cerebrovascular Disease: A Critical Reappraisal with Focus on Human Studies

“…In this model, higher LMR predicted the presence of chronic CVT with high specificity and sensitivity. This last theory is supported by case–control studies, which associated lower LMR with worse clinical outcomes [ 32 , 44 , 45 ].…”

“…Retrospective studies have shown a positive correlation between NLR and baseline degree of disability and NIHSS. Different studies have also shown that NLR is an independent risk factor for poor prognosis in patients with Cerebral Venous Sinus Thrombosis (CVST), significantly associated with a high risk of poor outcome at discharge and unfavorable functional outcome at 90 days, although no relation to brain lesion outcomes or recanalization was found [ 32 , 33 , 34 ]. Therapeutic data are still lacking, with only a preclinical study supporting neutropenia and neutralization of leukocyte adhesion molecules in effectively reducing blood–brain damage and brain edema [ 15 ].…”

“…In CVT, IL-6 was shown to be significantly associated with an unfavorable functional outcome at 90 days, defining a cut point of 2.7 pg/mL for a specificity of 81% and sensitivity of 78% [ 32 ].…”

“…In CVT, a prospective case–control study found that patients with parenchymal brain lesions had higher baseline concentrations when compared to controls [ 32 ]. Additionally, patients with venous recanalization showed an early decline of circulating MMP-9 and significantly lower levels on day 8 [ 32 ]. A higher MMP-9 on day 8 was associated with persistent venous occlusion [ 82 ].…”

“…In a study, hs-CRP level was positively correlated with the baseline occurrence of seizure in CVT [ 97 ]. Priority-CVT, a multicenter prospective cohort of recently diagnosed CVT, however, did not show a relation between CRP levels and brain lesion outcomes or recanalization [ 32 ]. Regarding outcome, increased CRP baseline concentrations had a significant association with the unfavorable functional outcome at 90 days [ 32 ].…”