Eklund Sanna A, Israelsson Hanna, Carlberg Bo, Malm Jan
1Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.
2Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; and.
J Neurosurg. 2022 Jun 10;138(2):476-482. doi: 10.3171/2022.4.JNS22125. Print 2023 Feb 1.
Vascular risk factors (VRFs) may act synergistically, and clinical decision support tools (CDSTs) have been developed that present vascular risk as a summarized score. Because VRFs are a major issue in patients with idiopathic normal pressure hydrocephalus (INPH), a CDST may be useful in the diagnostic workup. The objective was to compare 4 CDSTs to determine which one most accurately predicts short-term outcome and 10-year mortality after CSF shunt surgery in INPH patients.
One-hundred forty INPH patients who underwent CSF shunt surgery were included. For each patient, 4 CDST scores (Systematic Coronary Risk Evaluation-Older Persons [SCORE-OP], Framingham Risk Score [FRS], Revised Framingham Stroke Risk Profile, and Kiefer's Comorbidity Index [KCI]) were estimated. Short-term outcome (3 months after CSF shunt surgery) was defined on the basis of improvements in gait, Mini-Mental State Examination score, and modified Rankin Scale score. The 10-year mortality rate after surgery was noted. The CDSTs were compared by using Cox regression analysis, receiver operating characteristic curve analysis, and the chi-square test.
For 3 CDSTs, increased score was associated with increased risk of 10-year mortality. A 1-point increase in the FRS indicated a 2% higher risk of death within 10 years (HR 1.02, 95% CI 1.003-1.035, p = 0.021); SCORE-OP, 5% (HR 1.05, 95% CI 1.019-1.087, p = 0.002); and KCI, 12% (HR 1.12, 95% CI 1.03-1.219, p = 0.008). FRS predicted short-term outcome of surgery (p = 0.024). When the cutoff value was set to 32.5%, the positive predictive value was 80% and the negative predictive value was 48% (p = 0.012).
The authors recommend using FRS to predict short-term outcome and 10-year risk of mortality in INPH patients. The study indicated that extensive treatment of the risk factors of INPH may decrease risk of mortality. Clinical trial registration no.: NCT01850914 (ClinicalTrials.gov).
血管危险因素（VRF）可能具有协同作用，现已开发出临床决策支持工具（CDST），可将血管风险以汇总分数的形式呈现。由于VRF是特发性正常压力脑积水（INPH）患者的主要问题，CDST可能有助于诊断检查。目的是比较4种CDST，以确定哪一种能最准确地预测INPH患者脑脊液分流手术后的短期结局和10年死亡率。
纳入140例行脑脊液分流手术的INPH患者。为每位患者估算4种CDST评分（老年人系统性冠状动脉风险评估[SCORE-OP]、弗雷明汉姆风险评分[FRS]、修订的弗雷明汉姆卒中风险概况和基弗合并症指数[KCI]）。短期结局（脑脊液分流手术后3个月）根据步态、简易精神状态检查评分和改良Rankin量表评分的改善情况来定义。记录手术后的10年死亡率。使用Cox回归分析、受试者工作特征曲线分析和卡方检验对CDST进行比较。
对于3种CDST，评分升高与10年死亡率风险增加相关。FRS增加1分表明10年内死亡风险高出2%（风险比1.02，95%置信区间1.003 - 1.035，p = 0.021）；SCORE-OP为5%（风险比1.05，95%置信区间1.019 - 1.087，p = 0.002）；KCI为12%（风险比1.12，95%置信区间1.03 - 1.219，p = 0.008）。FRS可预测手术的短期结局（p = 0.024）。当临界值设定为32.5%时，阳性预测值为80%，阴性预测值为48%（p = 0.012）。
作者建议使用FRS来预测INPH患者的短期结局和10年死亡风险。该研究表明，对INPH的危险因素进行广泛治疗可能会降低死亡风险。临床试验注册号：NCT01850914（ClinicalTrials.gov）。
