Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St, APC 6, Providence, RI, 02903, USA.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
Sci Rep. 2023 Mar 29;13(1):5111. doi: 10.1038/s41598-023-32088-4.
A series of epidemiological studies have shown the limited life expectancy of patients suffering from idiopathic normal pressure hydrocephalus (iNPH). In most cases, comorbid medical conditions are the cause of death, rather than iNPH. Though it has also been shown that shunting improves both life quality and lifetime. We sought to investigate the utility of the Charlson comorbidity index (CCI) for improved preoperative risk-benefit assessment of shunt surgery in individual iNPH cases. 208 shunted iNPH cases were prospectively investigated. Two in-person follow up visits at 3 and 12 months assessed postoperative clinical status. The correlation of the age adjusted CCI with survival was investigated over the median observation time of 2.37 years (IQR 1.16-4.15). Kaplan Meier statistics revealed that patients with a CCI score of 0-5 have a 5-year survival rate of 87%, compared to only 55% in patients with CCI > 5. Cox multivariate statistics revealed that the CCI was an independent predictor of survival, while common preoperative iNPH scores (modified Rankin Scale (mRS), gait score, and continence score) are not. As expected, mRS, gait, and continence scores improved during the postoperative follow up period, though relative improvement on any of these was not predicted by baseline CCI. The CCI is an easily applicable preoperative predictor of survival time in shunted iNPH patients. The lack of a correlation between the CCI and functional outcome means that even patients with multiple comorbidities and limited remaining lifetime may appreciate benefit from shunt surgery.
一系列的流行病学研究表明，特发性正常压力脑积水（iNPH）患者的预期寿命有限。在大多数情况下，死亡的原因是合并症，而不是 iNPH。尽管已经表明分流术可以提高生活质量和寿命。我们试图研究 Charlson 合并症指数（CCI）在改善个体 iNPH 病例分流手术的术前风险效益评估中的作用。前瞻性研究了 208 例分流的 iNPH 病例。在术后 3 个月和 12 个月进行了两次面对面随访，评估术后临床状况。在中位观察时间 2.37 年（IQR 1.16-4.15）内，研究了年龄调整后的 CCI 与生存率的相关性。Kaplan-Meier 统计显示，CCI 评分为 0-5 的患者 5 年生存率为 87%，而 CCI>5 的患者生存率仅为 55%。Cox 多变量统计显示，CCI 是生存的独立预测因素，而常见的术前 iNPH 评分（改良 Rankin 量表（mRS）、步态评分和尿失禁评分）则不是。正如预期的那样，mRS、步态和尿失禁评分在术后随访期间有所改善，但基线 CCI 并不能预测任何这些评分的相对改善。CCI 是分流 iNPH 患者生存时间的一种易于应用的术前预测因子。CCI 与功能结果之间缺乏相关性意味着，即使是合并症多且剩余寿命有限的患者，也可能从分流手术中获益。
