Inflammatory biomarkers are correlated with thrombus burden in cerebral venous sinus thrombosis

Kula, Aslı Yaman; Kurtoğlu, Ahmet Volkan; Güzel, Vildan; Balsak, Serdar; Tak, Ayşegül Yabacı; Asil, Talip

doi:10.1055/s-0044-1787137

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Original Article • Arq. Neuro-Psiquiatr. 82 (5) • 2024 • https://doi.org/10.1055/s-0044-1787137 copy

Inflammatory biomarkers are correlated with thrombus burden in cerebral venous sinus thrombosis

Biomarcadores inflamatórios estão relacionados à carga trombótica na trombose venosa cerebral

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Increasing evidence suggests that inflammatory biomarkers play a significant role in cerebral venous sinus thrombosis (CVST). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are related to thrombotic conditions and indicators of systemic inflammation.

Objective

To analyze the correlation between inflammatory biomarkers and the extent of thrombus, determined by the CVST-Score.

Methods

A total of 40 patients with CVST (24 female subjects; 60%) and 40 age- and sex-matched healthy controls were retrospectively evaluated. Inflammatory biomarkers, including C-reactive protein (CRP), PLR, NLR, MLR, and the CVST-Score, were recorded to assess the relationship between biomarkers and thrombus burden. The patients were grouped according to symptom duration (group 1: 0–3 days; group 2: 4–7 days; and group 3: 8–30 days) to compare biomarker levels.

Results

The CRP, NLR, and PLR were significantly higher in the CVST group (p < 0.001; p = 0.003; p = 0.014 respectively). The NLR and PLR presented a significant positive correlation with the CVST-Score (p = 0.003, r = 0.464; p = 0.040, r = 0.326 respectively). The NLR was significantly higher in group 1 compared with groups 2 and 3 (p = 0.016 and p = 0.014 respectively). In group 1, there was a stronger positive correlation between the CVST-Score and the NLR (p = 0.026, r = 0.591) and the PLR (p = 0.012, r = 0.648). The multiple linear regression analysis revealed that the NLR is a key factor in predicting the CVST-Score (p = 0.019).

Conclusion

The NLR and PLR are associated with thrombus burden in CVST, especially in patients admitted to the hospital in the early stages. The NLR is an independent factor to predict the thrombus burden in CVST.

Keywords
Sinus Thrombosis, Intracranial; Biomarkers; Inflammation

Characteristics	CVST group: n = 40	Control group: n = 40	p
Female: n (%)	24 (60)	24 (60)	1^a a Notes: Chi-squared test.
Age (years): mean ± SD	39.67 ± 14.59	39.7 ± 14.55	0.994^b b Independent-samples t-test.
Hypertension: n (%)	11 (27.5)	10 (25)	0.827^a a Notes: Chi-squared test.
Diabetes mellitus: n (%)	4 (10)	6 (15)	0.527^a a Notes: Chi-squared test.
Alcohol consumption: n (%)	7 (17.5)	5 (12.5)	0.564^a a Notes: Chi-squared test.
Smoking: n (%)	10 (25)	6 (15)	0.317^a a Notes: Chi-squared test.
Pregnancy: n (%)	2 (5)	0 (0)	–
Postpartum period: n (%)	5 (12.5)	0 (0)	–

Inflammatory biomarkers	CVST group: n = 40	Control group: n = 40	p
CRP (mg/L): median (min–max)	2.70 (0.02–41.03)	0.44 (0.20–4.41)	< 0.001 ^a a Notes: Mann-Whitney U test.
Platelet (×10⁹/L): median (min–max)	269 (143–565)	250.50 (114–426)	0.548^a a Notes: Mann-Whitney U test.
Neutrophil (×10⁹/L): median (min–max)	5.87 (0.99–18.75)	4.44 (1.69–9.28)	0.004 ^a a Notes: Mann-Whitney U test.
Lymphocyte (×10⁹/L): mean ± SD	2.09 ± 0.74	0.44 ± 0.63	0.027 ^b b Independent-samples t-test.
Monocyte (× 10⁹/L), mean ± SD	0.64 ± 0.26	0.61 ± 0.17	0.611^b b Independent-samples t-test.
NLR: median (min–max)	2.88 (0.92–21.96)	2.08 (0.77–3.65)	0.003 ^a a Notes: Mann-Whitney U test.
PLR: median (min–max)	131.78 (57.50–391.74)	107.45 (42.29–191.52)	0.014 ^a a Notes: Mann-Whitney U test.
MLR: median (min–max)	0.28 (0.08–1)	0.25 (0.13–0.44)	0.071^a a Notes: Mann-Whitney U test.

	Optimal cut-off value	AAUC	95%CI		Sensitivity	Specificity	p
	Optimal cut-off value	AAUC	Lower limit	Upper limit	Sensitivity	Specificity	p
CRP	1.61	0.760	0.651	0.848	65	80	< 0.001
Neutrophil count	5.64 × 10⁹/L	0.686	0.572	0.785	60	70	0.018
Lymphocyte count	1.71 × 10⁹/L	0.635	0.520	0.740	37.50	92.50	0.031
NLR	3.65	0.680	0.566	0.779	68	97.50	0.003
PLR	157.89	0.650	0.534	0.752	70	95	0.001

	CVST groups (onset-to-door time)
Inflammatory biomarkers	Group 1 (0–3 days)		Group 2 (4–7 days)		Group 3 (8–30 days)
Inflammatory biomarkers	p	rho	p	rho	p	rho
CRP	0.493	-0.200	0.934	-0.030	0.274	0.291
Neutrophil count	0.135	0.420	0.580	0.200	0.460	0.199
Lymphocyte count	0.026*	-0.592	0.327	0.347	0.311	-0.271
NLR	0.026*	0.591	0.489	-0.248	0.374	0.238
PLR	0.012*	0.648	0.777	-0.103	0.405	0.224

CVST-Score	β	SE	95%CI	p
CRP	-0.105	0.087	-0.282:0.072	0.236
NLR	0.561	0.228	0.099:1.023	0.019
PLR	0.015	0.013	-0.012:0.042	0.273

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[1] Address for correspondence Asli Yaman Kula (email: dr.asliyaman@gmail.com)