Inflammatory biomarkers in cerebral venous thrombosis versus ischemic stroke: a network meta-analysis.

Background: In cerebrovascular diseases (CVD), the management strategies for ischemic stroke (IS) and cerebral venous thrombosis (CVT) have significant differences, but the underlying inflammation-driven mechanisms in these two conditions have not been fully translated into individualized intervention criteria. Methods: We searched PubMed, Embase, Web of Science and Cochrane Library through February 1, 2025, and included 18 eligible studies in a Bayesian network meta-analysis following PRISMA-NMA. The data were processed using Revman (version 5.4.1) and R (version 4.3.3). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method was used to assess the quality of evidence. This study was registered in PROSPERO (CRD42024539498). Results: In total, 18 studies were included in the review. The results showed that acute-phase inflammatory markers were significantly elevated in both CVT and IS. CVT was associated with a relatively stronger systemic inflammatory response, while lymphocyte counts were reduced in both, suggesting a immunosuppressive phenomenon in cerebral thrombotic disease. This network Meta-Analysis showed that CRP (MD = 7.58, 95% CI: 2.48-14.09) and IL-6 (MD = 6.98, 95% CI: 2.75-11.44) were more significantly elevated in the acute phase in CVT patients than in IS patients, suggesting they could serve as key inflammatory markers for differentiating the two conditions. Conclusion: Inflammatory markers exhibit both specific differences and shared characteristics in CVT and IS. CRP and IL-6 were higher in CVT than in IS in Bayesian NMA, suggesting potential adjunctive markers for differential diagnosis; however, these findings are hypothesis-generating and require prospective validation, and neuroimaging remains the diagnostic gold standard. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024539498, CRD42024539498.