1.Risk factors for shunt dependent hydrocephalus in patients with traumatic subarachnoid hemorrhage and establishment of their nomogram prediction model
Yi SUN ; Xi WANG ; Xingdong LIU ; Xiefeng WANG ; Yongping YOU ; Wei YAN
Chinese Journal of Neuromedicine 2022;21(10):1019-1025
Objective:To explore the risk factors for shunt dependent hydrocephalus (SDHC) in patients with traumatic subarachnoid hemorrhage (tSAH) and establish their risk nomogram model.Methods:Two hundred and sixty-nine patients with tSAH, admitted to our hospital from February 2018 to February 2022, were chosen in our study. All patients were followed up for 3 months after discharge; 51 patients were complicated with SDHC and 218 patients were not complicated with SDHC. The clinical data of patients with and without SDHC were compared. Multivariate Logistic regression analysis was used to determine the independent influencing factors for SDHC in tSAH patients; according to the results of multivariate Logistic regression analysis, a nomogram model was constructed to predict SDHC in tSAH patients; and the consistency index (C-index) and calibration curve were used to evaluate the predictive performance and compliance of the nomogram model.Results:As compared with patients without SDHC group, patients with SDHC had significantly lower Glasgow Coma Scale (GCS) scores on admission, and significantly higher proportions of patients with cerebral hernia, diffuse tSAH, tSAH thickness ≥5 mm, intraventricular hemorrhage, midline shift>12 mm, and epidural effusion at discharge, and patients accepted decompressive craniectomy ( P<0.05). Multivariate Logistic regression analysis showed that GCS scores of 13-15 ( OR=0.134, 95%CI: 0.024-0.740, P=0.021), diffuse tSAH ( OR=4.391, 95%CI: 1.680-11.475, P=0.003), tSAH thickness≥5 mm ( OR=4.114, 95%CI: 1.689-10.018, P=0.002), decompressive craniectomy ( OR=3.283, 95%CI: 1.278-8.433, P=0.014) and epidural hydrops ( OR=3.302, 95%CI: 1.137-9.593, P=0.028) were independent influencing factors for SDHC in tSAH patients. A nomogram model established based on the above 5 influencing factors showed high predictive accuracy with C-index of 0.877. Conclusion:The tSAH patients with low GCS scores at admission, diffuse tSAH, tSAH thickness≥5 mm, and epidural effusion, and patients accepted decompressive craniectomy are prone to have SDHC; the nomogram model based on the above variables has a high efficiency in predicting the risk of tSAH complicated with SDHC.