Construction And Validation Of A Predictive Model For The Risk Of Normal Pressure Hydrocephalus Risk Nomogram In Postoperative Patients With Aneurysmal Subarachnoid Hemorrhage

Objective:To uncover risk factors for normal pressure hydrocephalusin postoperative patients with aneurysmal subarachnoid hemorrhage,and to develop and internally validate a normal pressure hydrocephalus risk nomogram in postoperative patients with aneurysmal subarachnoid hemorrhage.Methods:Based on the inclusion criteria,512 patients with aSAH admitted to our neurosurgery department from January 2014 to October 2020 were collected.Demographic characteristics,Hunt-Hess score,Fisher scale,laboratory examination,and radiography were collected.NPH was assessed based on clinical history,physical examination,and imaging.The risk factors related to the occurrence of NPH were screened by independent analysis of t test and chi-square test,and the included factors were screened by stepwise regression method.Calibration charts,C-indices,ROC curves,and predictive model accuracy were used and evaluated using internal random sampling validation.Decision-making curves were drawn to determine clinical application range and benefits.Results:There was no difference in the incidence of NPH among different genders(P>0.05),intrventricular hemorrhage[OR=2.31,95%CI(1.26-4.10)],surgical method[OR=0.35,95%CI(0.12-0.81)],GCS score(9-12 points)[OR=2.30,95%CI(1.12-5.09)],GCS score(3-8 points)[OR=29.26,95%CI(12.47-74.02)],Hunt-hess score(3 points)[OR=2.44,95%CI(0.94-8.35)],Hunt-Hess score(4-5points)[OR=36.40,95%CI(12.36-135.89)],Fisher score(2points)[OR=20.24,95%CI(7.89-62.49)],Fisher score(3-4points)[OR=66.99,95%CI(27.00-204.00)],RBC[OR=0.64,95%CI(0.41-1.00)],WBC[OR=1.07,95%CI(1.02-1.15)],GR(OR=1.08,95%CI(1.02 1.15)],Age(OR=1.03,95%CI(1.00 1.06)],HCT(OR=0.006,95%CI(0.001 0.610)],RDW(OR=1.25,95%CI(1.05 1.49)],PLT(OR=1.004,95%CI(1.000 1.008)],FIB(OR=1.34,95%CI(1.05 1.69)],AST(OR=1.015,95%CI,1.007 1.023)],TBA(OR=1.06,95%CI(1.001.13)],apoB100(OR=3.71,95%CI(1.17 11.61)],Ca(OR=6.77,95%CI(1.16 40.10)],Urea(OR=1.15,95%CI(1.01 1.31)],Lact(OR=1.26,95%CI(1.08 1.50)].Both are independent risk factors for postoperative NPH in ASAH patients.The model C index of the prediction model developed in this study was 0.931(95%CI0.900-0.962),and the corrected C-index of the internal validation was 0.910.Decision curve analysis showed that when the risk of NPH was between 1%and 82%,the model could bring clinical benefits.Conclusions:Intraventricular hemorrhage,high Hunt-Hess score and Fisher score,advanced age,elevated RBC,WBC,GR,RDW,PLT,FIB,AST,TBA,apoB100,CA,Urea,and LACT all increased the risk of NPH.Embolization,reduced HCT,and high-scoring GCS reduced the risk of NPH.The prediction model developed in this study combined with age,surgical method,Hunt-Hess score,Fisher score,RBC,RDW and PCT can be used as a reference for the risk of postoperative NPH in aSAH patients.