Evaluation of plasma D-dimer plus fibrinogen in predicting acute CVST

Abstract

Background: Prompt diagnosis of cerebral venous sinus thrombosis is a challenge owing in part to its complex and non-specific early clinical symptoms.

Objective: This study aims to evaluate the value of clinically useful biomarkers (d-dimer and fibrinogen) for cerebral venous sinus thrombosis prediction.

Methods: Two-hundred and thirty-three suspected cerebral venous sinus thrombosis patients were enrolled in this prospective study. Thirty-four cases confirmed as cerebral venous sinus thrombosis using imaging modalities, whereas the other 199 cases served as mimic controls. Plasma samples of 34 healthy controls were further collected from age- and gender-matched volunteers. d-dimer and fibrinogen levels of all patients and controls were measured before imaging and treatment. The dynamic d-dimer and fibrinogen levels in cerebral venous sinus thrombosis cases after anticoagulation were monitored for up to 180 consecutive days.

Results: At admission before treatment the average d-dimer and fibrinogen levels in cerebral venous sinus thrombosis group were 968·9 ± 160·1 μg/l and 6·9 ± 1·3 g/l, both of which were significantly elevated when compared with that of the controls. In cerebral venous sinus thrombosis patients, 94·1% had d-dimer elevation, 73·5% had fibrinogen elevation, and 67·6% had both elevated d-dimer and fibrinogen. During acute phase, the sensitivity and specificity of predicting cerebral venous sinus thrombosis using only d-dimer were 94·1% and 97·5%, whereas that of d-dimer in combination with fibrinogen were 67·6% and 98·9%. After administering anticoagulation, d-dimer levels gradually recovered; however, fibrinogen levels fluctuated with 33·3% of the patients still exhibiting elevated values up until 180 days.

Conclusions: d-dimer may serve as an important screening tool to determine the urgency of obtaining magnetic resonance imaging/magnetic resonance venography or digital subtraction angiography in patients presenting with clinical symptoms that are suspected of cerebral venous sinus thrombosis. Furthermore, d-dimer in combination with fibrinogen may increase the predictive value of acute cerebral venous sinus thrombosis.

Keywords: acute; cerebral venous sinus thrombosis; d-dimer; fibrinogen.

Fig. 1

Plasma D-dimer levels in acute phase of CVST. Within seven-days after symptom onset, plasma D-dimer levels were measured and compared. **P < 0·001, CVST vs. mimic control, and CVST vs. healthy control. n = 34 for CVST group, n = 199 for mimic controls, and n = 34 for healthy controls. CVST, cerebral venous sinus thrombosis.

Fig. 2

Plasma fibrinogen levels in acute phase of CVST. Within seven-days after symptom onset, plasma fibrinogen levels were measured and compared. **P < 0·001, CVST vs. mimic controls, and CVST vs. healthy controls. n = 34 for CVST group, n = 199 for mimic controls, and n = 34 for healthy controls. CVST, cerebral venous sinus thrombosis.

Fig. 3

ROC curves of D-dimer within seven-days, at 30 days, and 90 days after symptom onset. The specificity and sensitivity of D-dimer on CVST prediction were described with ROC curves, n = 34 within seven-days, n = 32 at 30 days and 90 days after symptom onset. The area under the ROC curves for within seven-days vs. the area under the ROC curves for 30 days and 90 days, all P < 0·001. The blue line is the ROC (receiver operating characteristic curve), the green line is the standard curve. CVST, cerebral venous sinus thrombosis.

Fig. 4

ROC curves of fibrinogen within seven-days, at 30 days, and 90 days. The specificity and sensitivity of fibrinogen on CVST prediction were described with ROC curves, n = 34 within seven-days, n = 32 at 30 days and 90 days. The area under the ROC curves for within seven-days vs. the area under the ROC curves for 30 days and 90 days, all P < 0·001. The blue line is the ROC (receiver operating characteristic curve), the green line is the standard curve. CVST, cerebral venous sinus thrombosis.