Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis

Maria Khan; Antonio Arauz; Derya Uluduz; Miguel A Barboza; Taskin Duman; Vanessa Cano-Nigenda; Safia Awan; Mohammad Wasay; Venost Study Group

doi:10.1159/000527155

Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis

Cerebrovasc Dis. 2023;52(4):393-400. doi: 10.1159/000527155. Epub 2022 Dec 23.

Authors

Maria Khan¹, Antonio Arauz², Derya Uluduz³, Miguel A Barboza⁴, Taskin Duman⁵, Vanessa Cano-Nigenda², Safia Awan⁶, Mohammad Wasay⁶; Venost Study Group

Affiliations

¹ Rashid Hospital, Dubai, United Arab Emirates.
² Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico.
³ Neurology Department, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
⁴ Neurosciences Department, Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica.
⁵ Department of Neurology, School of Medicine, Mustafa Kemal University, Hatay, Turkey.
⁶ Department of Medicine, The Aga Khan University, Karachi, Pakistan.

PMID: 36566747
DOI: 10.1159/000527155

Abstract

Introduction: Cerebral venous thrombosis (CVT) associated with pregnancy and puerperium has long been recognized, with poor information in terms of functional outcomes. Our objective was to analyze risk factors, clinical, imaging, and laboratory variables to predict functional outcome and death in this population.

Methods: CVT registries from three referral centers from Pakistan, Turkey, and Mexico, recruiting prospective cases, were combined for CVT associated with pregnancy or puerperium. Datasets and variables were standardized. Demographic characteristics, presentation, risk factors, and functional outcomes in pregnancy/puerperium-related CVT were analyzed. Binary logistic regression was used to assess predictors of outcome. The main outcome was modified Rankin score >2 at 30 days and mortality at 30 days.

Results: Five hundred fifty-three cases (median age 28 years [IQR 23-34]) of CVT associated with pregnancy and puerperium were included; 439 cases (79.4%) happened in the puerperium and 20.6% during pregnancy (53.5% occurred during the first trimester). Anemia (36.7%) and dehydration (22.9%) were the commonest obstetric risk factors identified. Predictors of poor outcome (mRS >2) were encephalopathy (OR 12.8, p < 0.001), cases from Mexican origin (OR 3.1, p = 0.004), fever/puerperal infection (OR 2.7, p = 0.02), and anemia (OR 2.2, p = 0.01). Cases from Mexican origin (OR 12.0, p = 0.003) and Encephalopathy (OR 7.7, p < 0.001), presented with the highest mortality association in the final adjusted model.

Discussion/conclusion: In CVT associated with pregnancy and puerperium, encephalopathy, fever/puerperal infection, and anemia are associated with bad functional outcomes, meanwhile encephalopathy and cases from Mexican origin with higher mortality in the acute (30-days) of CVT onset. Anemia and infection are potential reversible predictors of poor outcome that clinicians should be aware of in order to prevent poor outcomes in these patients.

Keywords: Cerebral venous thrombosis; Pregnancy; Puerperium; Stroke; Women.

MeSH terms

Adult
Anemia* / complications
Brain Diseases* / complications
Female
Humans
Intracranial Thrombosis* / diagnostic imaging
Intracranial Thrombosis* / therapy
Postpartum Period
Pregnancy
Puerperal Infection*
Venous Thrombosis* / diagnostic imaging
Venous Thrombosis* / therapy