A new inflammatory parameter can predict delayed intracranial hemorrhage following ventriculoperitoneal shunt

Shiwei Li,Pandi Chen,Hongcai Wang,Feng Li,Maosong Chen

doi:10.1038/s41598-021-93315-4

Shiwei Li, Pandi Chen + Show 3 more

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https://doi.org/10.1038/s41598-021-93315-4

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Journal: Scientific Reports	Publication Date: Jul 2, 2021
Citations: 2	License type: open-access

Affiliation: Ningbo Medical Center Lihuili Hospital

Abstract

Delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is considered to be a potentially severe event. This study aimed to investigate the association between a ratio of postoperative neutrophil-to-lymphocyte ratio to preoperative neutrophil-to-lymphocyte ratio (NLRR) and DICH secondary to VP shunt. We performed a retrospective review of patients who underwent VP shunt between January 2016 and June 2020. Multivariable logistic regression analysis was used to assess the association of DICH and NLRR. Then patients were divided into two groups according to the optimal cut-off point of NLRR, propensity score matching (PSM) method was performed to reconfirm the result. A total of 130 patients were enrolled and DICH occurred in 29 patients. Elevated NLRR and history of craniotomy were independent risk factors for DICH secondary to VP shunt. The optimal cut off point of NLRR was 2.05, and the sensitivity was 89.7%, the specificity was 63.4%. Patients with NLRR > 2.05 had much higher incidence of DICH (40.6% vs 4.5%). Our finding suggested that DICH following VP shunt was not a rare complication and elevated NLRR could independently predict DICH. Inflammatory responses might play an important role in the development of DICH following VP shunt.

Highlights

Delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is considered to be a potentially severe event
Inclusion criteria were as follows: (1) age ≥ 18 years; (2) the diagnosis of hydrocephalus was confirmed by clinical symptoms and imaging examination, and VP shunt was performed in our hospital; (3) laboratory tests within 5 days before VP shunt, and blood routine on the first morning after VP shunt; (4) postoperative brain computed tomography (CT) scan was performed on the first day after operation, and at least one CT scan was performed within 5–10 days after operation
The exclusion criteria were as follows: (1) patients on a regimen of anticoagulant or antiplatelet therapy; (2) patients with Ommaya reservoir implantation, the Ommaya tube was directly connected to the shunt pump without ventricular puncture, or the Ommaya tube was removed during the surgery; (3) cranioplasty and VP shunt were performed simultaneously; (4) a revision of the VP shunt; (5) early intracerebral hemorrhage after VP shunt, which was defined as bleeding on the first day after operation

Summary

Introduction

Delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is considered to be a potentially severe event. Elevated NLRR and history of craniotomy were independent risk factors for DICH secondary to VP shunt. The delayed intracerebral hemorrhage (DICH) is considered to be a rare but potentially severe event[7], the mortality is as high as 50%4. We hereby hypothesize that inflammatory response is one of the mechanisms associated with DICH following VP shunt. Considering that the value of NLR is greatly influenced by the basic systemic inflammatory statuses such as pneumonia or urinary infection, we proposed a new parameter named NLRR, what is a ratio of postoperative NLR to preoperative NLR. We sought to test the hypothesis that elevated NLRR is associated with the DICH secondary to VP shunt

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