A scoring tool to predict mortality and dependency after cerebral venous thrombosis

BACKGROUND

We developed a prognostic score to predict dependency and death after cerebral venous thrombosis (CVT) to identify patients for targeted therapy in future clinical trials..

METHODS

We used data from the International CVT Consortium. We excluded patients with pre-existent functional dependency. We used logistic regression to predict poor outcome (modified Rankin Scale 3-6) at 6 months and Cox regression to predict 30-day and 1-year all-cause mortality. Potential predictors derived from previous studies were selected with backward stepwise selection. Coefficients were shrunken using Ridge regression to adjust for optimism in internal validation.

RESULTS

Of 1454 patients with CVT, the cumulative number of deaths was 44 (3%) and 70 (5%) for 30 days and 1 year, respectively. Of 1126 patients evaluated regarding functional outcome, 137 (12%) were dependent or dead at 6 months. From the retained predictors for both models, we derived the SI₂ NCAL₂ C score utilizing the following components: absence of female Sex-specific risk factor, Intracerebral hemorrhage, Infection of the central nervous system, Neurologic focal deficits, Coma, Age, lower Level of hemoglobin (g/L), higher Level of glucose (mmol/L) at admission, and Cancer. C-statistics were 0.80 (95%CI 0.75-0.84), 0.84 (95%CI 0.80-0.88) and 0.84 (95%CI 0.80-0.88) for the poor outcome, 30 days and 1 year mortality model, respectively. Calibration plots indicated good model fit between predicted and observed values. The SI₂ NCAL₂ C score calculator is freely available at www.cerebralvenousthrombosis.com.

CONCLUSIONS

The SI₂ NCAL₂ C score shows adequate performance for estimating individual risk of mortality and dependency after CVT but external validation of the score is warranted.

Biotransformation of some pyrazole derivatives to glutathione conjugates in rat liver subcellular fractions

During incubation of antipyrine, but not amidopyrine, 4-aminoantipyrine and 4-leucylaminoantipyrine, with rat liver microsomaland cytosol fractions in the presence of NADPH-generating system a reactive metabolite, which binds with glutathione is formed. The chemical nature of the metabolically activated intermediate is not known; it is suggested that the putative reactive metabolite responsible for this binding could be an epoxide.

Enzymatic hydrolysis of leucylaminoantipyrine in various tissues and subcellular fractions of rat liver and kidney

Enzymatic hydrolysis of L-leucylaminoantipyrine occurs in homogenates of kidney, small intestine, liver, lung, brain, spleen, heart and blood plasma. The activity of the drug hydrolyzing enzyme was found in all tested subcellular fractions of liver and kidney. In contrast to L-leucylaminoantipyrine, neither its stereoisomer D-nor 4-L-(N,N-dimethylleucylamino)-antipyrine undergoes enzymatic hydrolysis in any tissue tested. The results suggest, that in vivo L-leucylaminoantipyrine could be very rapidly hydrolyzed to 4-aminoantipyrine.