Abstract：
OBJECTIVE: Prognostication for cerebral venous thrombosis (CVT) remains difficult. We sought to validate the SI2NCAL2C score in an international cohort.
METHODS: The SI2NCAL2C score was originally developed to predict poor outcome (modified Rankin Scale (mRS) 3-6) at 6 months, and mortality at 30 days and 1 year using data from the International CVT Consortium. The SI2NCAL2C score uses 9 variables: the absence of any female-sex-specific risk factors, intracerebral hemorrhage, central nervous system infection, focal neurological deficits, coma, age, lower level of hemoglobin, higher level of glucose, and cancer. The ACTION-CVT study was an international retrospective study that enrolled consecutive patients across 27 centers. The poor outcome score was validated using 90-day mRS due to lack of follow-up at the 6-month time-point in the ACTION-CVT cohort. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Missing data were imputed using the additive regression and predictive mean matching methods. Bootstrapping was performed with 1000 iterations.
RESULTS: Mortality data were available for 950 patients and poor outcome data were available for 587 of 1,025 patients enrolled in ACTION-CVT. Compared to the International CVT Consortium, the ACTION-CVT cohort was older, less often female, and with milder clinical presentation. Mortality was 2.5% by 30 days and 6.0% by one year. At 90-days, 16.7% had a poor outcome. The SI2NCAL2C score had an AUC of 0.74 [95% CI 0.69-0.79] for 90-day poor outcome, 0.72 [0.60-0.82] for mortality by 30 days, and 0.82 [0.76-0.88] for mortality by one year.
CONCLUSIONS: The SI2NCAL2C score had acceptable to good performance in an international external validation cohort. The SI2NCAL2C score warrants additional validation studies in diverse populations and clinical implementation studies.
METHODS: The SI2NCAL2C score was originally developed to predict poor outcome (modified Rankin Scale (mRS) 3-6) at 6 months, and mortality at 30 days and 1 year using data from the International CVT Consortium. The SI2NCAL2C score uses 9 variables: the absence of any female-sex-specific risk factors, intracerebral hemorrhage, central nervous system infection, focal neurological deficits, coma, age, lower level of hemoglobin, higher level of glucose, and cancer. The ACTION-CVT study was an international retrospective study that enrolled consecutive patients across 27 centers. The poor outcome score was validated using 90-day mRS due to lack of follow-up at the 6-month time-point in the ACTION-CVT cohort. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Missing data were imputed using the additive regression and predictive mean matching methods. Bootstrapping was performed with 1000 iterations.
RESULTS: Mortality data were available for 950 patients and poor outcome data were available for 587 of 1,025 patients enrolled in ACTION-CVT. Compared to the International CVT Consortium, the ACTION-CVT cohort was older, less often female, and with milder clinical presentation. Mortality was 2.5% by 30 days and 6.0% by one year. At 90-days, 16.7% had a poor outcome. The SI2NCAL2C score had an AUC of 0.74 [95% CI 0.69-0.79] for 90-day poor outcome, 0.72 [0.60-0.82] for mortality by 30 days, and 0.82 [0.76-0.88] for mortality by one year.
CONCLUSIONS: The SI2NCAL2C score had acceptable to good performance in an international external validation cohort. The SI2NCAL2C score warrants additional validation studies in diverse populations and clinical implementation studies.
摘要：
目的：脑静脉血栓形成（CVT）的预后仍然很困难。我们试图在国际队列中验证SI2NCAL2C评分。
方法：SI2NCAL2C评分最初用于预测6个月时的不良结局（改良的Rankin量表（mRS）3-6），使用国际CVT联盟的数据，以及30天和1年时的死亡率。SI2NCAL2C评分使用9个变量：不存在任何女性特定的风险因素，脑出血，中枢神经系统感染,局灶性神经功能缺损,昏迷,年龄,血红蛋白水平较低，更高水平的葡萄糖，和癌症。ACTION-CVT研究是一项国际回顾性研究，纳入了27个中心的连续患者。在ACTION-CVT队列中，由于在6个月时间点缺乏随访，使用90天mRS验证了不良结局评分。使用接受者工作特征曲线下面积(AUC)和校准图评价模型性能。使用加法回归和预测均值匹配方法估算缺失数据。自举进行了1000次迭代。
结果：有950名患者的死亡率数据，有587名接受ACTION-CVT的1,025名患者的不良结局数据。与国际CVT联盟相比，ACTION-CVT队列年龄较大，女性较少，临床表现更温和。30天死亡率为2.5%，一年死亡率为6.0%。90天,16.7％的结果不佳。SI2NCAL2C评分90天不良结局的AUC为0.74[95％CI0.69-0.79]，30天死亡率为0.72[0.60-0.82]，一年死亡率为0.82[0.76-0.88]。
结论：SI2NCAL2C评分在国际外部验证队列中表现良好。SI2NCAL2C评分值得在不同人群和临床实施研究中进行其他验证研究。
方法：SI2NCAL2C评分最初用于预测6个月时的不良结局（改良的Rankin量表（mRS）3-6），使用国际CVT联盟的数据，以及30天和1年时的死亡率。SI2NCAL2C评分使用9个变量：不存在任何女性特定的风险因素，脑出血，中枢神经系统感染,局灶性神经功能缺损,昏迷,年龄,血红蛋白水平较低，更高水平的葡萄糖，和癌症。ACTION-CVT研究是一项国际回顾性研究，纳入了27个中心的连续患者。在ACTION-CVT队列中，由于在6个月时间点缺乏随访，使用90天mRS验证了不良结局评分。使用接受者工作特征曲线下面积(AUC)和校准图评价模型性能。使用加法回归和预测均值匹配方法估算缺失数据。自举进行了1000次迭代。
结果：有950名患者的死亡率数据，有587名接受ACTION-CVT的1,025名患者的不良结局数据。与国际CVT联盟相比，ACTION-CVT队列年龄较大，女性较少，临床表现更温和。30天死亡率为2.5%，一年死亡率为6.0%。90天,16.7％的结果不佳。SI2NCAL2C评分90天不良结局的AUC为0.74[95％CI0.69-0.79]，30天死亡率为0.72[0.60-0.82]，一年死亡率为0.82[0.76-0.88]。
结论：SI2NCAL2C评分在国际外部验证队列中表现良好。SI2NCAL2C评分值得在不同人群和临床实施研究中进行其他验证研究。
