D-dimers (DD) in CVST

Sadowski

et al. 2020

Neurol Neurochir Pol.

Aim of the study. We investigated whether D-dimer (DD) concentration is elevated in cerebral venous and sinus thrombosis (CVST), as has been reported in the literature. Clinical rationale for the study. CVST is a disease with variable clinical presentations and a challenging diagnosis. We looked into whether D-dimer concentration might be an indicator of CVST, and the need for neuroimaging tests correlated with clinical factors. Materials and methods. We included all consecutive patients (mean age 41.6 years) with CVST treated in our neurology department from 2014 to 2018 whose DD levels had been measured. DD concentrations were categorised as normal (≤ 0.5 μg/ml) or elevated (> 0.5 μg/ml). Appropriate imaging confirmed the diagnosis of CVST. The results were compared to those of a control group consisting of 22 age-and sex-matched patients (mean age 40 years) with a diagnosis of primary headache (tension type or migraine) hospitalised to exclude secondary causes. Results. In 20 patients in the CVST study group, median level of DD was 1.0 + 0.57 μg/ml (range 0.19-2.45 μg/ml), compared to the control group's mean DD level of 0.50 + 0.45 μg/ml (range 0.15-1.73 μg/ml), with p < 0.005. Higher DD levels were associated with complications of the disease and fatal course (p < 0.005). One female and one male patient died because of CVST with DD levels of (respectively) 2.45 and 1.80 μg/ml-the two highest concentrations in our study group. Conclusions and clinical implications. DD concentration, especially in headache patients, may be a factor to predict CVST and an indicator for further diagnostic procedures with venography. But in clinical practice, low levels of DD cannot be taken to exclude CVST.

Section: Discussion and Clinical Implicationssupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Cerebral venous and sinus thrombosis diagnosis: preliminary study of clinical picture and D-dimer concentration correlation

Sadowski

et al. 2020

Neurol Neurochir Pol.

“…We selected acute/subacute patients from our database. Inclusion criteria were as follows: (1) meeting the diagnostic criteria for CVST established by the American Heart Association/American Stroke Association in 2014 8 ; (2) lling defect or obstruction of cerebral sinus in the magnetic resonance venogram, digital subtraction angiography, or operation searching; (3) clinical features such as vomiting, visual disturbances, focal neurologic de cit, seizure, and other typical symptoms; (4) acute and subacute patients whose time from onset to addition was less than 30 days 13,14 , or named non-chronic patients; (5) an initial blood sample for laboratory testing 12 hours of admission. Exclusion criteria were as follows: (1) patients with unrelated other serious brain lesions, serious lung disease, or heart disease; (2) patients with undesirable follow-up, including refusal or loss to follow-up; (3) patients less than 18 years old; (4) patients without complete clinical data; (5) chronic patients whose time from onset to addition was more than 30 days.…”

Section: Patient Selectionmentioning

confidence: 99%

The Novel Biomarkers-Based HALP (Hemoglobin, Albumin, Lymphocyte and Platelet)-Prognostic Model for Acute and Subacute Patients with Cerebral Venous Sinus Thrombosis: A Retrospective Cohort Study

Shen

Gao

Zhao

et al. 2020

Preprint

Background and purpose: To evaluate the prognosis values of HALP in acute or subacute cerebral venous sinus thrombosis (CVST), to explore the new prognostic model for CVST.Methods: Consecutive patients who were diagnosed as having acute and subacute CVST were retrospectively investigated. We determined the patients' functional outcomes by modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to assess the relationship between factors and poor functional outcomes. The area under the ROC curve (AUC) was estimated to evaluate the ability of markers and models in predicting clinical prognosis. The prognostic model was presented as nomogram. In addition, the decision curve analysis (DCA) was used to analyze the benefit of this model. Furthermore, survival curves were described by the Kaplan‑Meier analysis. Results: A total of 270 patients were included of which 31 had poor outcome. Multivariable logistic regression analysis demonstrated HALP (OR=0.978, 95%CI: 0.958-0.999, P=0.039) was a protective predictor of outcome. The AUC of HALP was 0.749 (95% CI: 0.633-0.865, P=0.044). DCA demonstrated that this model significantly improved risk prediction at threshold probabilities of CVST at 0 to 85%. Patients with higher HALP (P=0.006) presented higher overall survival rates. Conclusions: HALP may be a potential protective marker in acute and subacute CVST patients. The new prognostic model with HALP had potentially better value for Chinese CVST patients.

“…Hal ini sesuai dengan literatur bahwa sebagian besar kasus CVST terjadi pada perempuan. 1,[2][3][4][5] Subjek penelitian memiliki rentang usia dari 19-65 tahun. Sebanyak 87,5% subjek penelitian ini terdiagnosis CVST melalui DSA dengan lokasi terbanyak ada di sinus transversus kiri.…”

Section: Pada Penelitian Ini Didapatkan Bahwa 80%unclassified

“…Beberapa penelitian sebelumnya menyebutkan bahwa kadar D-dimer plasma berhubungan dengan diagnosis CVST. [2][3][4][5] Rekomendasi dari American Heart Association (AHA) dan American Stroke Association (ASA) menyebutkan bahwa pasien dengan kadar D-dimer yang tinggi dapat mengindikasikan kemungkinan adanya CVST, dibandingkan dengan nilai D-dimer yang normal. Penelitian yang telah dilakukan di China didapatkan bahwa, pasien yang telah didiagnosis CVST dan memiliki kadar D-dimer yang tinggi memiliki kecenderungan lebih lamanya berkurang gejala dibandingkan dengan yang memiliki kadar D-dimer normal.…”

unclassified

Hubungan Kadar D-Dimer Dengan Awitan Gejala Dan Lama Perawatan Pada Penderita Cerebral Venous Sinus Thrombosis Di Rsup DR Hasan Sadikin Bandung

Amalia

Nugroho

2020

CORRELATION BETWEEN D-DIMER LEVEL WITH ONSET OF SYMPTOMS AND LENGTH OF STAY IN CEREBRAL VENOUS SINUS THROMBOSIS PATIENTS AT HASAN SADIKIN HOSPITAL BANDUNGABSTRACTIntroduction:Cerebral venous sinus thrombosis (CVST)is one of a cerebrovascular disease with a diverse and elusive clinical presentation. Diagnosis is often challenging due to limitation in diagnostic tools.Coagulation disorder is one of the risk factor for CVST that can be seen from D-dimer level which tends to increase in CVST patients.Aim: This study aims to determine the D-dimer leveland its correlation with onset of symptoms and length of stay in CVST patients at Hasan Sadikin Hospital, Bandung.Methods: This is a cross-sectional study. The inclusion criteria were patients at Hasan Sadikin Hospital, Bandung diagnosed as CVST, confirmed by digital subtraction angiography (DSA) or computed tomography angiography (CTA) or magnetic resonance angiography (MRA) and had blood coagulation profile in the period of January 2018-May 2019. Exclusion criteria were patients with infection or sepsis. Data were collected from the patient’s medical record. Statistical value was calculated with Spearman rank test, p value<0.05 was considered significant.Results: Forty CVST patients met the criteria. CVST mostly occurred in women (80%), the mean age were 40,75 years, and had headache as primary symptom (70%). Twenty-eight(70%) patients had increased level of D-dimer. D-dimer level had negative correlation with onset of symptoms (r=-0.319, p=0.045). However, it hadassociationwith length of stay (p=0.012).Discussion: D-dimer level in CVST patients tends to increase above normal value. D-dimer level have correlation with onset of symptoms and length of stay in CVST patients.Keywords:Cerebral venous sinus thrombosis, D-dimer level, length of stay, onset of symptomsABSTRAK Pendahuluan: Trombosis pada vena serebral (cerebral venous sinus thrombosis/CVST) merupakan salah satu diagnosis dalam bidang cerebrovaskular yang sulit ditegakkan karena keterbatasan alat untuk diagnosis pasti. Salah satu faktor risiko terjadinya CVST adalah kelainan koagulasi yang dapat dilihat dari kadar D-dimer yang cenderung meningkat.Tujuan: Mengetahui gambaran profil D-dimer pada penderita CVST dan hubungannya dengan awitan gejala dan lama perawatan di RSUP Dr. Hasan Sadikin, Bandung.Metode: Penelitian ini merupakan penelitian potong lintang. Kriteria inklusi yaitu pasien yang terdiagnosis CVST melalui pemeriksaan digital substraction angiography (DSA) atau computed tomography angiography (CTA) atau magnetic resonance angiography (MRA) dan memiliki profil koagulasi serta dirawat di RSUP Dr. Hasan Sadikin, Bandung pada periode Januari 2018–Mei 2019. Kriteria eksklusi yaitu pasien yang disertai infeksi atau sepsis. Data diambil dari penelusuran rekam medis pasien dan dianalisis menggunakan korelasi Spearman. Signifikansi dinyatakan bila p<0,05.Hasil: Terdapat 40 pasien CVST yang memenuhi kriteria inklusi. CVST mayoritas terjadi pada perempuan (80%), rerata usia 40,75 tahun dengan keluhan utama tersering adalah nyeri kepala (70%). Terdapat 28 pasien memiliki kadar D-dimer yang meningkat (70%). Berdasarkan analisis, kadar D-dimer memiliki hubungan negatif dengan awitan gejala pasien (r=0,319, p= 0,045). Kadar D-dimer juga memiliki hubungan dengan lama perawatan (p=0,012).Diskusi: Kadar D-dimer pada penderita CVST cenderung lebih tinggi dari nilai normal. Kadar D-dimer memiliki hubungan dengan awitan gejala dan lama perawatan pasien CVST di rumah sakit.Kata kunci: Awitan gejala, cerebral venous sinus thrombosis, kadar D-dimer, lama perawatan