脑静脉窦血栓形成患者院内恶化的影响因素

Factors associated with in-hospital deterioration in cerebral venous thrombosis

目的 确定脑静脉窦血栓形成(CVT)患者院内恶化的影响因素。方法 分析2017年1月至2019年6月期间在北京航天总医院和首都医科大学宣武医院住院治疗的成人初次CVT患者。收集一般人口学资料、入院时临床和影像特征以及院内恶化的信息。院内恶化定义为入院后出现任何新的或恶化的神经系统症状和体征。以出院后1年随访时的mRS来评估功能预后,预后不良定义为残疾或死亡(mRS>2)。通过多因素Logistic逻辑回归分析来确定院内恶化的影响因素以及院内恶化对远期功能预后的影响。结果 共纳入了138例CVT患者,中位年龄为34岁,81例患者(58.7%)为女性。入院后43例患者(31.2%)出现病情恶化。发病时间是唯一与院内恶化独立相关的因素(OR,0.932;95%CI,0.874-0.993;P=0.029)。院内恶化与残疾或死亡独立相关(OR,3.733;95%CI,1.013-13.755;P=0.048)。结论 大约30%的CVT患者出现院内病情恶化,入院时发病时间较短的患者可能具有更高的病情恶化的风险,因此需要更密切的病情监护。院内恶化可能与长期预后不良有关。

Objective To identify the factors associated with in-hospital deterioration of patients with cerebral venous thrombosis(CVT).Methods We retrospectively included adult patients with CVT who were admitted to Beijing Aerospace General Hospital and Xuanwu Hospital of Capital Medical University from January 2017 to June 2019.The diagnosis of CVT was confirmed by MRI+MRV,CTV or conventional cerebral angiography.Data on demographic factors,clinical and imaging characteristics on admission,and in-hospital neurological deterioration were collected by searching the emergency and inpatient medical record system of the two centers.In-hospital deterioration was defined as any new or worsening neurological symptoms after admission.Functional outcome was assessed with modified Rankin Scale score at the follow-up of 12 months after discharge.Poor outcome was defined as death or dependency(mRS> 2).Multivariable Logistic regression analysis was used to determine the influencing factors of inhospital deterioration and the association between in-hospital worsening and long-term functional outcome.Results A total of 138 patients were included,with the median age of 34 years(IQR 24.75-46),and 81(58.7%) were female.The median admission delay was 4 days(IQR 2-10.25).In-hospital deterioration was observed in 43 patients(31.2%).In multivariable Logistic regression,earlier admission was the only predictor of in-hospital deterioration(OR,0.932;95% CI,0.874-0.993;P=0.029).In-hospital deterioration was independently associated with poor outcome(OR,3.733;95% CI,1.013-13.755;P=0.048).Conclusions In-hospital deterioration occurred in about 30% of CVT patients.Patients admits earlier may need closer monitoring due to the higher risk of deterioration.In-hospital deterioration may be associated with long-term poor outcome.