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. 2023 Mar 28;7(3):100130.
doi: 10.1016/j.rpth.2023.100130. eCollection 2023 Mar.

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 , Elisabeth Masson Fron  2 , Ludovic Drouet  2 , Isabelle Crassard  3 , Raphaël Marlu  4 , Marianne Barbieux-Guillot  5 , Pierre-Emmanuel Morange  6 , Emmanuelle Robinet  7 , Catherine Metzger  8 , Valérie Wolff  9 , Elisabeth André-Kerneis  10 , Frédéric Klapczynski  11 , Brigitte Martin-Bastenaire  12 , Fernando Pico  13 , Fanny Menard  14 , Emmanuel Ellie  15 , Geneviève Freyburger  16 , François Rouanet  17 , Hong-An Allano  18 , Gaëlle Godenèche  19 , Guillaume Mourey  20 , Thierry Moulin  21 , Micheline Berruyer  22 , Laurent Derex  23 , Catherine Trichet  24 , Gwénaëlle Runavot  25 , Agnès Le Querrec  26 , Fausto Viader  27 , Sophie Cluet-Dennetiere  28 , Thomas Tarek Husein  29 , Magali Donnard  30 , Francisco Macian-Montoro  31 , Catherine Ternisien  32 , Benoît Guillon  33 , Sophie Laplanche  34 , Mathieu Zuber  35 , Jean-Yves Peltier  36 , Philippe Tassan  37 , Bertrand Roussel  38 , Sandrine Canaple  39 , Emilie Scavazza  40 , Nicolas Gaillard  41 , Aude Triquenot Bagan  42 , Véronique Le Cam Duchez  1
Affiliations

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 et al. Res Pract Thromb Haemost. .

Abstract

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.

Keywords: D-dimer; cerebral venous sinus thrombosis; high-sensitivity C-reactive protein; thrombin generation assay.

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