Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Oncology Neurosurgery Division, Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung, 40705, Taiwan, ROC.
Sci Rep. 2024 Nov 2;14(1):26462. doi: 10.1038/s41598-024-76752-9.
Intraventricular hemorrhage (IVH) occurs in approximately 30-50% patients with spontaneous intracerebral hemorrhage (ICH), with a high 30-day mortality rate. Excess accumulation of parenchymal or ventricular blood associated with the development of acute hydrocephalus leads to poor outcomes. The prediction of shunt dependency is important to identify patients susceptible to requiring permanent shunt placement and benefit from the diversion. This retrospective analytical study aimed to establish a predictive model of shunt dependency in patients with IVH. This study included 179 patients with primary IVH with supratentorial origin or spontaneous ICH with extension into the ventricles between 2015 and 2021. Patients were grouped into "shunt required" and "shunt not required" groups. Variables, including age, sex, preexisting hypertension and diabetes, initial Glasgow Coma Scale scores, ICH location and volume, urokinase administration, modified Graeb score (mGraeb score), and bicaudate index, were analyzed. The shunt required group had significantly higher mGraeb scores (12.0 (6.5-15.0) vs. 7.0 (4.0-12.0), p = 0.001) and higher bicaudate index (0.20 (0.17-0.23) vs. 0.16 (0.13-0.18), P < 0.001) than the shunt not required group. The receiver operating characteristic curve (ROC curve) analysis revealed that a cut-off value of 0.16 of the bicaudate index was significantly related to shunt dependency. The subgroup statistical analysis revealed that neither urokinase administration (p = 0.533) nor urokinase dosage (p = 0.117) showed significant relevance in shunt dependency in patients who received external ventricular drainage. In logistic regression adjusted for the confounders, thalamic ICH (odds ratio (OR) 3.55; 95% confidence interval [(95%CI), 1.13-11.18], an mGraeb score greater than 8 (OR, 3.93; 95%CI, 1.84-8.38), and a bicaudate index greater than 0.16 (OR, 9.87; 95%CI, 3.79-25.73) were factors associated with a higher tendency for shunting. The findings of this study may help identify patients at risk for a permanent shunt after IVH.
脑室内出血（IVH）发生在约 30-50%自发性脑出血（ICH）患者中，30 天死亡率较高。实质或脑室中血液的过度积聚与急性脑积水的发展相关，导致不良结局。分流依赖性的预测对于确定需要永久性分流的患者以及受益于分流的患者非常重要。这项回顾性分析性研究旨在建立 IVH 患者分流依赖性的预测模型。这项研究纳入了 2015 年至 2021 年间原发性幕上起源 IVH 或自发性 ICH 延伸至脑室的 179 例患者。患者被分为“需要分流”和“不需要分流”两组。分析了年龄、性别、既往高血压和糖尿病、初始格拉斯哥昏迷量表评分、ICH 部位和体积、尿激酶治疗、改良 Graeb 评分（mGraeb 评分）和双丘指数等变量。需要分流的组 mGraeb 评分明显更高（12.0（6.5-15.0）vs. 7.0（4.0-12.0），p=0.001），双丘指数也更高（0.20（0.17-0.23）vs. 0.16（0.13-0.18），P<0.001）。受试者工作特征曲线（ROC 曲线）分析显示，双丘指数 0.16 的截断值与分流依赖性显著相关。亚组统计分析显示，尿激酶治疗（p=0.533）和尿激酶剂量（p=0.117）与接受外部脑室引流的患者的分流依赖性均无显著相关性。在调整混杂因素的逻辑回归中，丘脑 ICH（优势比（OR）3.55；95%置信区间（95%CI），1.13-11.18）、mGraeb 评分大于 8（OR，3.93；95%CI，1.84-8.38）和双丘指数大于 0.16（OR，9.87；95%CI，3.79-25.73）是与更高分流倾向相关的因素。这项研究的结果可能有助于识别 IVH 后需要永久性分流的患者。
