Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis
Abstract Background Cerebral venous sinus thrombosis is a rare stroke with several clinical manifestations. Several studies have identified prognostic risk factors associated with poor functional outcomes and established predictive models. This systematic review and meta-analysis assessed the overal...
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2025-02-01
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| Online Access: | https://doi.org/10.1186/s12883-025-04059-x |
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| author | Lili Lin Senfeng Liu Wei Wang Xiao-kuo He Muhammad Hibatullah Romli Ruthpackiavathy Rajen Durai |
| author_facet | Lili Lin Senfeng Liu Wei Wang Xiao-kuo He Muhammad Hibatullah Romli Ruthpackiavathy Rajen Durai |
| author_sort | Lili Lin |
| collection | DOAJ |
| description | Abstract Background Cerebral venous sinus thrombosis is a rare stroke with several clinical manifestations. Several studies have identified prognostic risk factors associated with poor functional outcomes and established predictive models. This systematic review and meta-analysis assessed the overall effect size of all prognostic risk factors. Methods A systematic review was conducted to explore all prognostic risk factors in studies published from the initial to June 2024 among 5 Databases included PubMed / Medline, Scopus, EBSCOhost, Web of Science, and Cochran Library. The quality of the methodology was analyzed using the Newcastle–Ottawa Scale. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 29. Results Sixty-four studies involving 18,958 participants with a mean age of 38.46 years and females 63.03% were included in the quantitative meta-analysis. Functional outcomes were primarily measured using the Modified Rankin Scale (mRS), with scores ≥ 2 or ≥ 3 indicating poor outcomes in 35.00% and 60.00% of studies, respectively. For general information, age (InOR = 0.98, 95% CI 0.53–1.43), intracranial hemorrhage (OR = 3.79, 95% CI 2.77–5.20), and ischemic infarction (OR = 3.18, 95% CI 2.40–4.23) were associated with poor functional outcomes. For general and neurological symptoms, headache (OR = 0.22, 95% CI 0.17–0.29), seizure (OR = 2.74, 95% CI 1.76–4.27), focal deficit (OR = 4.72, 95% CI 3.86–5.78), coma (OR = 11.60, 95% CI 6.12–21.98), and consciousness alteration (OR = 7.07, 95% CI 4.15–12.04) were outstanding factors. The blood biomarkers of NLR (log OR = 1.72, 95% CI 0.96–2.47), lymphocytes (Cohen’s d = -0.63, 95 CI -0.78—-0.47), and D-dimer (lnOR = 1.34, 95% CI 0.87–1.80) were the three most frequently reported factors. Parenchymal lesion (OR = 4.71, 95% CI 1.12–19.84) and deep cerebral venous thrombosis (OR = 6.30, 95% CI 2.92–13.63) in radiological images were two frequently reported factors. CVST patients with cancer (OR = 3.87, 95% CI 2.95–5.07) or high blood glucose levels (OR = 3.52, 95% CI 1.61–7.68) were associated with poor functional outcomes. In the meta-regression analysis, ischemic infarction (P = 0.032), consciousness alteration (P < 0.001), and NLR (P = 0.015) were associated with mRS prediction. Conclusions Pooled effect sizes revealed that ischemic infarction, headache, neurological focal deficit, lymphopenia, and cancer were significantly associated with poor functional outcomes, with low to moderate heterogeneity. Consciousness alterations/deterioration and deep cerebral venous thrombosis were also significant prognostic factors, albeit with substantial heterogeneity. The meta-regression analysis showed that the effect sizes of consciousness alterations/deterioration and NLR increased with worsening mRS scores. Other notable risk factors included age, intracranial hemorrhage, seizures, coma, D-dimer, parenchymal lesions, and hyperglycemia. This systematic review provides a comprehensive overview of the prognostic risk factors for poor functional outcomes in patients undergoing CVST, which can guide clinical decision-making and future research. Trial registration This systematic review and meta-analysis has been registered with INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols), and the registration number is INPLASY202480072. The registration period is 14 August 2024. |
| format | Article |
| id | doaj-art-8968e718ac8843688b7626571844119e |
| institution | Kabale University |
| issn | 1471-2377 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | BMC Neurology |
| spelling | doaj-art-8968e718ac8843688b7626571844119e2025-02-09T12:43:08ZengBMCBMC Neurology1471-23772025-02-0125111910.1186/s12883-025-04059-xKey prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysisLili Lin0Senfeng Liu1Wei Wang2Xiao-kuo He3Muhammad Hibatullah Romli4Ruthpackiavathy Rajen Durai5Faculty of Medicine and Health Sciences, University Putra MalaysiaFaculty of Environment and Public Health, Xiamen Huaxia UniversityDepartment of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Neurology, The Fifth Xiamen HospitalFaculty of Medicine and Health Sciences, University Putra MalaysiaFaculty of Medicine and Health Sciences, University Putra MalaysiaAbstract Background Cerebral venous sinus thrombosis is a rare stroke with several clinical manifestations. Several studies have identified prognostic risk factors associated with poor functional outcomes and established predictive models. This systematic review and meta-analysis assessed the overall effect size of all prognostic risk factors. Methods A systematic review was conducted to explore all prognostic risk factors in studies published from the initial to June 2024 among 5 Databases included PubMed / Medline, Scopus, EBSCOhost, Web of Science, and Cochran Library. The quality of the methodology was analyzed using the Newcastle–Ottawa Scale. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 29. Results Sixty-four studies involving 18,958 participants with a mean age of 38.46 years and females 63.03% were included in the quantitative meta-analysis. Functional outcomes were primarily measured using the Modified Rankin Scale (mRS), with scores ≥ 2 or ≥ 3 indicating poor outcomes in 35.00% and 60.00% of studies, respectively. For general information, age (InOR = 0.98, 95% CI 0.53–1.43), intracranial hemorrhage (OR = 3.79, 95% CI 2.77–5.20), and ischemic infarction (OR = 3.18, 95% CI 2.40–4.23) were associated with poor functional outcomes. For general and neurological symptoms, headache (OR = 0.22, 95% CI 0.17–0.29), seizure (OR = 2.74, 95% CI 1.76–4.27), focal deficit (OR = 4.72, 95% CI 3.86–5.78), coma (OR = 11.60, 95% CI 6.12–21.98), and consciousness alteration (OR = 7.07, 95% CI 4.15–12.04) were outstanding factors. The blood biomarkers of NLR (log OR = 1.72, 95% CI 0.96–2.47), lymphocytes (Cohen’s d = -0.63, 95 CI -0.78—-0.47), and D-dimer (lnOR = 1.34, 95% CI 0.87–1.80) were the three most frequently reported factors. Parenchymal lesion (OR = 4.71, 95% CI 1.12–19.84) and deep cerebral venous thrombosis (OR = 6.30, 95% CI 2.92–13.63) in radiological images were two frequently reported factors. CVST patients with cancer (OR = 3.87, 95% CI 2.95–5.07) or high blood glucose levels (OR = 3.52, 95% CI 1.61–7.68) were associated with poor functional outcomes. In the meta-regression analysis, ischemic infarction (P = 0.032), consciousness alteration (P < 0.001), and NLR (P = 0.015) were associated with mRS prediction. Conclusions Pooled effect sizes revealed that ischemic infarction, headache, neurological focal deficit, lymphopenia, and cancer were significantly associated with poor functional outcomes, with low to moderate heterogeneity. Consciousness alterations/deterioration and deep cerebral venous thrombosis were also significant prognostic factors, albeit with substantial heterogeneity. The meta-regression analysis showed that the effect sizes of consciousness alterations/deterioration and NLR increased with worsening mRS scores. Other notable risk factors included age, intracranial hemorrhage, seizures, coma, D-dimer, parenchymal lesions, and hyperglycemia. This systematic review provides a comprehensive overview of the prognostic risk factors for poor functional outcomes in patients undergoing CVST, which can guide clinical decision-making and future research. Trial registration This systematic review and meta-analysis has been registered with INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols), and the registration number is INPLASY202480072. The registration period is 14 August 2024.https://doi.org/10.1186/s12883-025-04059-xCerebral venous sinus thrombosisStrokePrognosisFunctional outcome |
| spellingShingle | Lili Lin Senfeng Liu Wei Wang Xiao-kuo He Muhammad Hibatullah Romli Ruthpackiavathy Rajen Durai Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis BMC Neurology Cerebral venous sinus thrombosis Stroke Prognosis Functional outcome |
| title | Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis |
| title_full | Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis |
| title_fullStr | Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis |
| title_full_unstemmed | Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis |
| title_short | Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis |
| title_sort | key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis a systematic review and meta analysis |
| topic | Cerebral venous sinus thrombosis Stroke Prognosis Functional outcome |
| url | https://doi.org/10.1186/s12883-025-04059-x |
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