Article
Blood clearing rate in the basal cisterns and the external CSF spaces in relationship to treatment with ventriculo-peritoneal shunting in patients with a subarachnoid hemorrhage
Blutauswaschrate in den basalen Zysternen und den äußeren Liquorräumen und Korrelation zu ventrikuloperitonealer Shunt-Behandlung bei subarachnoidaler Blutung
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Authors
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Athanasios Petridis
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Angelika Zhivotovskaya
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Jan Frederick Cornelius
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Hans-Jakob Steiger
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Patients suffering from aneurysmal subarachnoid haemorrhage (aSAH) are at risk for the development of chronic hydrocephalus. Identification of patients that become shunt-dependent remains challenging. The objective of this study was to evaluate the prognostic potentials of patient demographics, clinical grades, treatment factors, and radiological variables including time till blood clearance in the cerebrospinal fluid (CSF) spaces on the development of shunt-dependent hydrocephalus in a cohort of patients following aSAH.
Methods: We retrospectively analysed 227 patients with aSAH treated at our tertiary institution from January 2012 to January 2016. The outcome was VP-Shunt placement in the first 30 days after aSAH. The following prognostic factors were considered for each candidate: age, WFNS grade, Fisher grade, external ventricular drainage (EVD), ventricular and intracerebral haemorrhage, and days to blood clearance in the peripheral and basal CSF spaces. Adjusting for multiple testing using Benjamini-Hochberg calculations was performed. A prognostic model was developed using multivariate logistic regression analysis. Bootstrapping was applied for internal validation. Model performance measures included indices for explained variance (R2), calibration (graphical plot and Hosmer-Lemeshow test), and discrimination (concordance (c)-statistic).
Results: 90 (39.6%) of the patients required a VP-Shunt. The constructed prognostic model combined EVD placement, presence of ventricular blood with duration of blood clearance in the basal cisterns. Model performance was promising: R2=33% (20% after internal validation), the calibration was considered adequate according to the plot and the Hosmer-Lemeshow test. Furthermore, the c-statistic was found to be 0.85 (0.84 after internal validation) indicating a good discriminating prognostic model.
Conclusion: The developed prognostic model may help to identify patients needing a permanent CSF diversion after aSAH, although additional modification and external validation is needed. Interventions aiming to accelerate the clearance of blood in the basal cisterns seem to have potential to prevent the development of chronic hydrocephalus following aSAH.
