Abstract Body: Background: The inflammatory response plays a critical role in the pathogenesis of severe cerebral venous thrombosis(CVT). However, the potential benefits of anti-inflammatory therapy in CVT patients remain debated. This study aimed to explore the association between steroids combined with anticoagulants treatment and prognosis in patients with acute/subacute severe CVT.
Methods: This prospective cohort study included patients with acute/subacute severe CVT treated at our Hospital from July 2020 to January 2024. We compared functional outcomes(modified Rankin Scale, mRS score≤2) and major adverse events at 6 months post-discharge between the steroid group and the nonsteroid group.
Results: A total of 107 patients in the steroid group and 58 patients in the nonsteroid group were included in the analysis. Compared to the nonsteroid group, the steroid group had a higher likelihood of achieving mRS score of 0-2(93.5% versus 82.5%, OR=2.98, P=0.037) at 6 months follow-up. After adjusting for confounding factors or conducting subgroup analyses(including only patients with an admission mRS>0 or mRS>2), steroid treatment remained associated with a higher likelihood of achieving an mRS score of 0-2(all P<0.05). Steroid pulsed therapy did not increase mortality during hospitalization or follow-up, nor did it lead to severe steroid-related complications(all P>0.05). Additionally, propensity score matching was utilized to create a matched dataset, and the analysis results before and after matching were consistent. In the steroid group, there was a significant reduction in serum hs-CRP, IL-6, cerebrospinal fluid IL-6, and intracranial pressure at discharge compared to admission levels, as well as a significant reduction in the fundoscopic Frisén grade at 6 months post-discharge(all P<0.001). The reduction in serum inflammatory markers during hospitalization was positively correlated with improvements in functional outcomes(P<0.05).
Conclusion: Short-term use of steroids may be an effective and safe adjuvant therapy for acute/subacute severe CVT when used alongside standard anticoagulant treatment. Its benefits are likely related to the suppression of the inflammatory response in severe CVT. However, these findings require further validation through randomized controlled trials.