A sustained systemic inflammatory response syndrome is associated with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage.
OBJECTIVEThe authors sought to evaluate whether a sustained systemic inflammatory response was associated with shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage.METHODSA retrospective analysis of 193 consecutive patients with aneurysmal subarachnoid hemorrhage was performed. Management of hydrocephalus followed a stepwise algorithm to determine the need for external CSF drainage and subsequent shunt placement. Systemic inflammatory response syndrome (SIRS) data were collected for all patients during the first 7 days of hospitalization. Patients who met the SIRS criteria every day for the first 7 days of hospitalization were considered as having a sustained SIRS. Univariate and multivariate regression analyses were used to determine predictors of shunt dependence.RESULTSSixteen percent of patients required shunt placement. Sustained SIRS was observed in 35% of shunt-dependent patients compared to 14% in non-shunt-dependent patients (p = 0.004). On multivariate logistic regression, female sex (OR 0.35, 95% CI 0.142-0.885), moderate to severe vasospasm (OR 3.78, 95% CI 1.333-10.745), acute hydrocephalus (OR 21.39, 95% CI 2.260-202.417), and sustained SIRS (OR 2.94, 95% CI 1.125-7.689) were significantly associated with shunt dependence after aneurysmal subarachnoid hemorrhage. Receiver operating characteristic analysis revealed an area under the curve of 0.83 for the final regression model.CONCLUSIONSSustained SIRS was a predictor of shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage even after adjustment for potential confounding variables in a multivariate logistic regression model.
['Wessell|Aaron P|AP|', 'Kole|Matthew J|MJ|', 'Cannarsa|Gregory|G|', 'Oliver|Jeffrey|J|', 'Jindal|Gaurav|G|', 'Miller|Timothy|T|', 'Gandhi|Dheeraj|D|', 'Parikh|Gunjan|G|', 'Badjatia|Neeraj|N|', 'Aldrich|E Francois|EF|', 'Simard|J Marc|JM|']
hydrocephalus subarachnoid hemorrhage shunt AUC = area under the curve CTA = CT angiography DND = delayed neurological deficit DSA = digital subtraction angiography EVD = external ventricular drain MFS = modified Fisher scale NF = nuclear factor ROC = receiver operating characteristic SIRS = systemic inflammatory response syndrome TGF = transforming growth factor WFNS = World Federation of Neurosurgical Societies cerebral aneurysm inflammation vascular disorders