European neurology · 2026
Validation of the DIAS3 Score in Cerebral Venous Thrombosis Patients Treated by Decompressive Surgery.
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Taveira Mariana C, Sanchez van Kammen Mayte, Aaron Sanjith, Ferreira Jorge M, Coutinho Jonathan M, Canhão Patrícia, Conforto Adriana B, Arauz Antonio, Carvalho Marta, Masjuan Jaime, Sharma Vijay K, Putaala Jukka, Uyttenboogaart Maarten, Werring David J, Bazan Rodrigo, Mohindra Sandeep, Weber Jochen, Coert Bert A, Kirubakaran Prabhu, Singh Pankaj, Aguiar de Sousa Diana, Ferro José M
Аннотация
INTRODUCTION: Cerebral venous thrombosis (CVT) is associated with a risk of late seizures, particularly in patients with severe disease requiring decompressive surgery. The DIAS3 score was developed to predict late seizures after CVT, but its performance in surgically treated patients is unknown. We aimed to validate the DIAS3 score in a high-risk cohort of CVT patients treated by decompressive surgery.
METHODS: This was a substudy of the DECOMPRESS2 - a prospective, multicenter cohort, including patients with CVT treated with decompressive surgery. Patients with available data on the occurrence and timing of seizures following CVT were included. Late seizures were defined as those occurring more than 7 days after CVT diagnosis, up to 1-year follow-up. We calculated DIAS3 score for all included patients. Predictive performance was assessed only for the 1-year risk of late seizures. Discrimination was evaluated using receiver operating characteristic analysis, and calibration by comparing predicted and observed seizure risks. Diagnostic performance was assessed across multiple probability thresholds.
RESULTS: In total, 89 patients were included (median age 38 years; 69.7% female). Late seizures occurred in 22 (24.7%) patients. The mean predicted 1-year seizure risk according to the DIAS3 score was 28.4%. The DIAS3 score showed poor discrimination (area under the curve 0.44, 95% confidence interval 0.30-0.59) and poor calibration. Across all tested thresholds, sensitivity and specificity showed an expected trade-off, but overall predictive accuracy was limited.
CONCLUSION: The DIAS3 score demonstrated poor discrimination and calibration in CVT patients treated by decompressive surgery. These findings suggest that the DIAS3 score should not be used to predict late seizures in this high-risk surgical subgroup.
METHODS: This was a substudy of the DECOMPRESS2 - a prospective, multicenter cohort, including patients with CVT treated with decompressive surgery. Patients with available data on the occurrence and timing of seizures following CVT were included. Late seizures were defined as those occurring more than 7 days after CVT diagnosis, up to 1-year follow-up. We calculated DIAS3 score for all included patients. Predictive performance was assessed only for the 1-year risk of late seizures. Discrimination was evaluated using receiver operating characteristic analysis, and calibration by comparing predicted and observed seizure risks. Diagnostic performance was assessed across multiple probability thresholds.
RESULTS: In total, 89 patients were included (median age 38 years; 69.7% female). Late seizures occurred in 22 (24.7%) patients. The mean predicted 1-year seizure risk according to the DIAS3 score was 28.4%. The DIAS3 score showed poor discrimination (area under the curve 0.44, 95% confidence interval 0.30-0.59) and poor calibration. Across all tested thresholds, sensitivity and specificity showed an expected trade-off, but overall predictive accuracy was limited.
CONCLUSION: The DIAS3 score demonstrated poor discrimination and calibration in CVT patients treated by decompressive surgery. These findings suggest that the DIAS3 score should not be used to predict late seizures in this high-risk surgical subgroup.