C-reactive protein and D-dimer in cerebral vein thrombosis: Relation to clinical and imaging characteristics as well as outcomes in a French cohort study

Paul Billoir (1) , Virginie Siguret (2, 3) , Elisabeth Masson Fron , Ludovic Drouet (2) , Isabelle Crassard (2) , Raphaël Marlu (4) , Marianne Barbieux-Guillot , Pierre-Emmanuel Morange , Emmanuelle Robinet (5) , Catherine Metzger , Valérie Wolff (6) , Elisabeth André-Kerneis , Frédéric Klapczynski (7) , Brigitte Martin-Bastenaire , Fernando Pico (8) , Fanny Menard , Emmanuel Ellie (9) , Geneviève Freyburger , François Rouanet (10) , Hong-An Allano , Gaëlle Godenèche , Guillaume Mourey , Thierry Moulin , Micheline Berruyer , Laurent Derex , Catherine Trichet , Gwénaëlle Runavot , Agnès Le Querrec , Fausto Viader , Sophie Cluet-Dennetiere , Thomas Tarek Husein , Magali Donnard , Francisco Macian-Montoro , Catherine Ternisien , Benoît Guillon , Sophie Laplanche , Mathieu Zuber , Jean-Yves Peltier , Philippe Tassan , Bertrand Roussel , Sandrine Canaple (11, 12) , Emilie Scavazza , Nicolas Gaillard , Aude Triquenot Bagan , Véronique Le Cam Duchez

1 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
2 Hôpital Lariboisière-Fernand-Widal [APHP]
3 IThEM - U1140 - Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis
4 TIMC-TrEE - Translational microbial Evolution and Engineering
5 CRMBM - Centre de résonance magnétique biologique et médicale
6 Service de Neurologie [Strasbourg]
7 Centre Hospitalier de Meaux
8 CHV - Centre Hospitalier de Versailles André Mignot
9 CHCB - Centre Hospitalier de la Côte Basque
10 CHU Bordeaux [Bordeaux]
11 CHU Amiens-Picardie
12 LNFP - Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559

Introduction Cerebral venous sinus thrombosis (CVST) is a rare disease with highly variable clinical presentation and outcomes. Clinical studies suggest a role of inflammation and coagulation in CVST outcomes. The aim of this study was to investigate the association of inflammation and hypercoagulability biomarkers with CVST clinical manifestations and prognosis. Methods This prospective multicenter study was conducted from July 2011 to September 2016. Consecutive patients referred to 21 French stroke units and who had a diagnosis of symptomatic CVST were included. High-sensitivity C-reactive protein (hs-CRP), neutrophil-to-lymphocyte ratio (NLR), D-dimer, and thrombin generation using calibrated automated thrombogram system were measured at different time points until 1 month after anticoagulant therapy discontinuation. Results Two hundred thirty-one patients were included. Eight patients died, of whom 5 during hospitalization. The day 0 hs-CRP levels, NLR, and D-dimer were higher in patients with initial consciousness disturbance than in those without (hs-CRP: 10.2 mg/L [3.6-25.5] vs 23.7 mg/L [4.8-60.0], respectively; NLR: 3.51 [2.15-5.88] vs 4.78 [3.10-9.59], respectively; D-dimer: 950 μg/L [520-2075] vs 1220 μg/L [950-2445], respectively). Patients with ischemic parenchymal lesions (n = 31) had a higher endogenous thrombin potential5pM than those with hemorrhagic parenchymal lesions (n = 31): 2025 nM min (1646-2441) vs 1629 nM min (1371-2090), respectively (P = .0082). Using unadjusted logistic regression with values >75th percentile, day 0 hs-CRP levels of >29.7 mg/L (odds ratio, 10.76 [1.55-140.4]; P = .037) and day 5 D-dimer levels of >1060 mg/L (odds ratio, 14.63 [2.28-179.9]; P = .010) were associated with death occurrence. Conclusion Two widely available biomarkers measured upon admission, especially hs-CRP, could help predict bad prognosis in CVST in addition to patient characteristics. These results need to be validated in other cohorts.

Domaines: Neurosciences [q-bio.NC]

Paul Billoir, Virginie Siguret, Elisabeth Masson Fron, Ludovic Drouet, Isabelle Crassard, et al.. C-reactive protein and D-dimer in cerebral vein thrombosis: Relation to clinical and imaging characteristics as well as outcomes in a French cohort study. Research and Practice in Thrombosis and Haemostasis, 2023, 7 (3), pp.100130. ⟨10.1016/j.rpth.2023.100130⟩. ⟨hal-04083689⟩