Risk factors for delayed intracranial hemorrhage secondary to ventriculoperitoneal shunt: A retrospective study

doi:10.12998/wjcc.v10.i21.7302

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World Journal of Clinical Cases

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Retrospective Study

World J Clin Cases. Jul 26, 2022; 10(21): 7302-7313
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7302

Table 1 Demographical characteristics and clinical data of the patients

Variables	DICH group (n = 26)	Non-DICH group (n = 133)	P value
Age (yr)	51.35 ± 12.08	53.89 ± 15.17	0.422
Male gender, n (%)	17 (65.38)	66 (49.62)	0.141
Primary intracranial lesion, n (%)			0.679
Traumatic brain injury	6 (23.07)	43 (17.29)
Intracranial hemorrhage	5 (19.23)	30 (22.56)
SAH (aneurysm rupture)	10 (38.46)	29 (21.80)
SAH (AVM rupture)	0 (0)	0 (0)
Cerebral infarction	0 (0)	0 (0)
Tumor	2 (7.69)	8 (6.02)
Infection	0 (0)	4 (3.01)
Primary hydrocephalus	3 (11.54)	19 (14.29)
Pre-Craniotomy, n (%)	9 (34.62)	56 (42.11)	0.477
Pre-Decompression, n (%)	8 (30.77)	50 (37.59)	0.508
Pre-EVD, n (%)	16 (61.54)	42 (31.58)	0.004^a
Pre-Cranioplasty, n (%)	2 (7.69)	23 (17.29)	0.350
LP pressure (mmH₂O)	141.54 ± 60.93	139.42 ± 64.94	0.878
CSF protein (g/L)	0.56 ± 0.46	0.64 ± 0.60	0.509
CSF glucose (mmol/L)	3.87 ± 1.45	3.88 ± 1.35	0.980
CSF nucleated cells (10⁶/L)	16.31 ± 20.16	11.68 ± 17.15	0.223
WBC (10⁹/L)	8.37 ± 3.10	7.97 ± 2.82	0.512
Neutrophils (10⁹/L)	5.55 ± 2.97	5.41 ± 2.63	0.810
Lymphocyte (10⁹/L)	1.89 ± 0.55	1.75 ± 0.59	0.237
NLR	3.40 ± 2.79	3.48 ± 2.20	0.869
RBC (10¹²/L)	4.04 ± 1.54	3.88 ± 0.69	0.407
HGB (g/L)	112.88 ± 15.44	114.71 ± 18.15	0.631
PLT (10⁹/L)	276.31 ± 68.61	280.92 ± 102.98	0.827
PLR	160.46 ± 69.01	184.02 ± 105.17	0.275
PT(s)	11.64 ± 1.24	11.40±1.26	0.374
INR	1.01 ± 0.11	0.99 ± 0.11	0.382
Fib (g/L)	4.88 ± 7.40	3.67 ± 1.60	0.416
Potassium (mmol/L)	3.85 ± 0.42	3.81 ± 0.43	0.680
Sodium (mmol/L)	136.68 ± 5.19	138.34 ± 5.30	0.144
Calcium (mmol/L)	2.23 ± 0.12	2.22 ± 0.17	0.796
Blood glucose (mmol/L)	5.92 ± 1.45	6.17 ± 2.34	0.591
SBP (mmHg)	137.46 ± 21.35	140.14 ± 24.84	0.609
DBP (mmHg)	86.50 ± 13.22	85.71 ± 14.08	0.791
Hypertension, n (%)	10 (38.46)	49 (36.84)	0.876
Other basic disease, n (%)	3 (11.54)	16 (12.03)	1.000
Smoker, n (%)	7 (26.92)	31 (23.31)	0.693
Prior Blood transfusion, n (%)	6 (23.08)	48 (36.09)	0.200
Operation time (min)	73.46 ± 34.58	74.35 ± 26.86	0.883
Location of VP shunt, n (%)			0.250
Frontal	23 (88.46)	101 (75.94)
Occiptal	3 (11.54)	32 (24.06)
Other VP Complications, n (%)	1 (3.85)	10 (7.52)	0.801
Brain edema around catheter, n (%)	15 (57.69)	34 (25.56)	0.000^a
Pre-mRS, n (%)			0.281
Low (0-2)	8 (30.77)	56 (42.11)
High (3-5)	18 (69.23)	77 (57.89)
Post-mRS, n (%)			0.024
Low (0-2)	9	77
High (3-5)	17	55

^aP < 0.05.

AVM: Arteriovenous malformation; CSF: Cerebrospinal fluid; DBP: Diastolic blood pressure; DICH: Delayed intracranial hemorrhage; EVD: External ventricular drain; HGB: Hemoglobin; LP: Lumbar puncture; INR: International normalized ratio; NLR: Neutrophil to lymphocyte ratio; mRS: Modified Rankin Scale; PLR: Platelet to lymphocyte ratio; PLT: Platelet; PT: Prothrombin time; RBC: Red blood cell; SAH: Subarachnoid hemorrhage; SBP: Systolic blood pressure; VP: Ventriculoperitoneal; WBC: White blood cell.

Table 2 Univariate analysis of variable relating to delayed intracranial hemorrhage in ventriculoperitoneal shunt patients

Variables	DICH group (n = 26)	Non-DICH group (n = 133)	P value
Demographics
Age (yr)	51.35 ± 12.08	53.89 ± 15.17	0.420
Male gender, n (%)	17 (65.38)	66 (49.62)	0.145
Primary clinical diagnosis, n (%)
Traumatic brain injury	6 (23.07)	43 (17.29)
Intracranial hemorrhage	5 (19.23)	30 (22.56)
SAH (aneurysm rupture)	10 (38.46)	29 (21.80)
SAH (AVM rupture)	0 (0)	0 (0)
Cerebral infarction	0 (0)	0 (0)
Tumor	2 (7.69)	8 (6.02)
Infection	0 (0)	4 (3.01)
Primary hydrocephalus	3 (11.54)	19 (14.29)
Pre-Craniotomy, n (%)	9 (34.62)	56 (42.11)	0.479
Pre-Decompression, n (%)	8 (30.77)	50 (37.59)	0.510
Pre-EVD, n (%)	16 (61.54)	42 (31.58)	0.005^a
Pre-Cranioplasty, n (%)	2 (7.69)	23 (17.29)	0.233
LP pressure (mmH₂O)	141.54 ± 60.94	139.42 ± 64.94	0.877
CSF protein (g/L)	0.56 ± 0.46	0.64 ± 0.60	0.509
CSF glucose (mmol/L)	3.87 ± 1.45	3.88 ± 1.35	0.980
CSF nucleated cells (10⁶/L)	16.31 ± 20.16	11.68 ± 17.15	0.229
WBC (10⁹/L)	8.37 ± 3.10	7.97 ± 2.82	0.510
Neutrophils (10⁹/L)	5.55 ± 2.97	5.41 ± 2.63	0.808
Lymphocyte (10⁹/L)	1.89 ± 0.55	1.75 ± 0.59	0.237
NLR	3.40 ± 2.79	3.48 ± 2.20	0.868
RBC (10¹²/L)	4.04 ± 1.54	3.88 ± 0.69	0.415
HGB (g/L)	112.88 ± 15.44	114.71 ± 18.15	0.629
PLT (10⁹/L)	276.31 ± 68.61	280.92 ± 102.97	0.826
PLR	160.46 ± 69.01	184.02 ± 105.17	0.276
PT(s)	11.64 ± 1.24	11.40 ± 1.26	0.373
INR	1.01 ± 0.11	0.99 ± 0.11	0.381
Fib (g/L)	4.88 ± 7.40	3.67 ± 1.60	0.183
Potassium (mmol/L)	3.85 ± 0.42	3.81 ± 0.43	0.678
Sodium (mmol/L)	136.68 ± 5.19	138.34 ± 5.30	0.145
Calcium (mmol/L)	2.23 ± 0.12	2.2238 ± 0.17	0.795
Blood glucose (mmol/L)	5.92 ± 1.45	6.17 ± 2.34	0.589
SBP (mmHg)	137.46 ± 21.35	140.14 ± 24.84	0.607
DBP (mmHg)	86.50 ± 13.22	85.71 ± 14.08	0.790
Hypertension, n (%)	10 (38.46)	49 (36.84)	0.876
Other basic disease, n (%)	3 (11.54)	16 (12.03)	0.944
Smoker, n (%)	7 (26.92)	31 (23.31)	0.693
Prior Blood transfusion, n (%)	6 (23.08)	48 (36.09)	0.205
Operation time (min)	73.46 ± 34.58	74.35 ± 26.86	0.882
Location of VP shunt, n (%)			0.170
Frontal	23 (88.46)	101 (75.94)
Occiptal	3 (11.54)	32 (24.06)
Other VP complications, n (%)	1 (3.85)	10 (7.52)	0.508
Brain edema around catheter, n (%)	15 (57.69)	34 (25.56)	0.000^a
Pre-mRS, n (%)			0.523
0-2	8 (30.77)	56 (42.11)
3-5	18 (69.23)	77 (57.89)

^aP < 0.05.

Table 3 Multivariate analysis of variable relating to delayed intracranial hemorrhage in ventriculoperitoneal shunt patients

Variable	P value	OR	95%CI
Age (yr)	0.162	0.975	0.942-1.010
Pre-Craniotomy	0.548	0.723	0.250-2.085
Pre-EVD	0.045	2.814	1.024-7.730
PT(s)	0.224	1.268	0.865-1.859
Location of VP shunt	0.153	2.775	0.685-11.249
Brain edema around catheter	0.000	8.397	3.043-23.171

CI: Confidence interval; EVD: External ventricular drain; OR: Odds ratio; PT: Prothrombin time; VP: Ventriculoperitoneal.

Table 4 Summary of 26 patients with delayed intracranial hemorrhage after ventriculoperitoneal shunt

No.	Age/sex	Primary intracranial lesion	History of EVD	Location of VP shunt	DICH type	Onsetday	Treatment	Pre-mRS	Post-mRS
1	50/F	Aneurysm	Y	Frontal	IVH	2	Conservative	1	1
2	67/M	ICH	Y	Frontal	ICH around catheter	3	Conservative	3	1
3	64/M	Aneurysm	Y	Frontal	IVH	1	Conservative	1	1
4	37/F	Tumor	N	Occipital	ICH around catheter	11	Conservative	5	4
5	56/M	TBI	Y	Frontal	ICH around catheter	3	Conservative	5	5
6	23/M	TBI	N	Frontal	ICH around catheter	4	Conservative	5	5
7	63/F	Aneurysm	N	Frontal	ICH around catheter	7	Surgery	4	5
8	54/M	Aneurysm	Y	Frontal	ICH around catheter	3	Conservative	5	5
9	61/M	Aneurysm	Y	Occipital	ICH around catheter	5	Conservative	2	1
10	47/M	ICH	Y	Frontal	ICH around catheter	7	Conservative	5	5
11	58/M	Aneurysm	Y	Frontal	IVH	7	Conservative	2	2
12	51/F	Aneurysm	N	Frontal	ICH around catheter	3	Conservative	1	1
13	58/M	Tumor	N	Frontal	ICH around catheter	2	Conservative	5	5
14	58/F	Primary hydrocephalus	N	Frontal	Subdural hematoma	7	Conservative	5	5
15	47/M	Primary hydrocephalus	N	Frontal	ICH around catheter	5	Conservative	4	4
16	53/M	TBI	Y	Frontal	IVH	2	Conservative	5	3
17	42/M	Aneurysm	Y	Frontal	ICH around catheter	9	Conservative	5	5
18	32/M	Aneurysm	Y	Occipital	IVH	1	Conservative	2	2
19	45/M	TBI	Y	Frontal	ICH around catheter	1	Conservative	5	5
20	62/M	ICH	Y	Frontal	Subdural hematoma	2	Conservative	5	5
21	47/F	TBI	Y	Frontal	ICH around catheter	2	Conservative	4	4
22	56/M	ICH	N	Frontal	IVH	7	Conservative	5	4
23	47/M	ICH	N	Frontal	Subdural hematoma	4	Surgery	5	5
24	26/F	Primary hydrocephalus	Y	Frontal	IVH	8	Conservative	2	2
25	72/F	Aneurysm	Y	Frontal	IVH	1	Conservative	1	1
26	59/F	TBI	N	Frontal	IVH	1	Conservative	5	5

EVD: External ventricular drain; F: Female; ICH: Intracranial hemorrhage; IVH: Intraventricular hemorrhage; M: Male; mRS: Modified Rankin Scale; N: No; TBI: Traumatic brain injury; VP: Ventriculoperitoneal; Y: Yes.

Table 5 Summary of the previous studies of delayed intracranial hemorrhage after ventriculoperitoneal shunt

Ref.	Year	DICH	Non-DICH	Number of variables	Proposed risk factors
Hudson et al[18]	2018	8	72	10	DAPT (P = 0.0001, OR = 31.23, 95%CI: 2.98-327.32)
Guo et al[15]	2017	20	512	8	Advanced age (P = 0.027, OR = 1.048, 95%CI: 1.005-1.092), craniotomy history (P = 0.025, OR = 3.874, 95%CI: 1.183-12.693), brain edema around the catheter (P < 0.001, OR = 9.056, 95%CI: 3.194-25.675)
Gong et al[16]	2017	12	742	9	Age ≥ 60 yr (P = 0.0008), prior craniotomy operation (P = 0.0001) and manipulation of the valve system (P = 0.0017)
Qian et al[14]	2017	11	140	18	Postoperative LMWH therapy (P = 0.026, relative ratio = 4.8, 95%CI: 1.4-17.1)
Jang et al[17]	2018	34	104	9	Old age (P = 0.037) and delayed PTT (P = 0.032)
Li et al[6]	2021	29	101	21	Elevated NLRR (P < 0.001, OR = 2.792, 95%CI: 1.747-4.460); history of craniotomy (P = 0.010, OR = 3.394, 95%CI: 1.060-10.869)

DAPT: Dual antiplatelet therapy; NLRR: A ratio of postoperative neutrophil-to-lymphocyte ratio to preoperative neutrophil-to-lymphocyte ratio; LMWH: Low-molecular-weight heparin; OR: Odds ratio; PTT: Partial thromboplastin time; DICH: Delayed intracranial hemorrhage.

Citation: Chen JC, Duan SX, Xue ZB, Yang SY, Li Y, Lai RL, Tan DH. Risk factors for delayed intracranial hemorrhage secondary to ventriculoperitoneal shunt: A retrospective study. World J Clin Cases 2022; 10(21): 7302-7313
URL: https://www.wjgnet.com/2307-8960/full/v10/i21/7302.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i21.7302