gms | German Medical Science

Objective: Chronic hydrocephalus malresorptivus is a common complication after aneurysmal subarachnoidal hemorrhage (SAH). Aim of this study was to define the potential of cerebrospinal fluid markers (CSF) markers for predicting shunt dependency after SAH.

Methods: This single center analysis included 63 consecutive patients with SAH and external ventricular drain (EVD) who were treated in our neurosurgical intensive care unit between January 2013 and October 2015. The following CSF markers were routinely measured and were available for retrospective analysis: glucose, total protein (TP), red blood cell count (RBCC), interleukin-6 (IL-6) and EVD volume. Differences in mean CSF marker concentrations over time in patients with and without shunt dependency were compared using students t-test. Receiver-operating-characteristic (ROC) curves with corresponding area-under-the-curve (AUC), sensitivity (SE) and specificity (SP) were calculated on days with significantly increased CSF marker levels.

Results: In patients with shunt-dependency TP levels were significantly increased on day 5 (TPd5), day 11 (TPd11) and day 14 (TPd14), IL-6 on day 14 (IL-6d14) and RBCC on day 15 (RBCCd15). ROC analysis revealed very high predictive potential for TP d11 (AUCd11= 0.97, cutoff = 97.5 mg/dl, SE= 1.0, SP = 0.9) and TPd14 (AUCd14 = 0.98, cutoff = 83.5 mg/dl, SE= 1.0, SP = 0.95) and a good predictive potential for IL-6d14 (AUC= 0.81) and RBCCd15 (AUC= 0.83). The number of patients with EVD-associated ventriculitis did not differ significantly in patients with and without shunt dependency (p> 0.05).

Conclusion: Increased TP, RBCC and IL-6 levels concentrations in the CSF during the second week after SAH may help to identify patients at risk for chronic shunt dependency.