Risk Factors Of Subacute Hydrocephalus After Endovascular Treatment For Aneurysmal Subarachnoid Hemorrhage

Objective:Hydrocephalus(HCP)is one of the serious complications after aneurysmal subarachnoid hemorrhage(a SAH).Most patients need cerebrospinal fluid drainage to relieve compression symptoms.Hydrocephalus can lead to defects in cognitive function and damage to nervous system function,which seriously affects the prognosis of patients.At present,the treatment of a SAH is mainly endovascular interventional therapy and intracranial clipping.In recent years,endovascular interventional therapy has gradually become the choice of most patients due to its advantages of small trauma and rapid recovery.However,the literature points out that the incidence of hydrocephalus after endovascular treatment is higher than that after intracranial clipping.In the clinical diagnosis and treatment of a SAH,it was found that compared with acute and chronic hydrocephalus,we did not pay much attention to subacute hydrocephalus,which caused great hidden dangers and affected the therapeutic effect.Subacute hydrocephalus is closely related to chronic hydrocephalus and prognosis due to the timing of occurrence(3-14 days after a SAH).Therefore,early intervention and treatment of subacute hydrocephalus can help improve the prognosis of patients.In this study,we selected the case data of a SAH patients treated by endovascular intervention to explore the risk factors of subacute hydrocephalus in a SAH patients after operation,and to provide reference for early identification of high-risk patients with subacute hydrocephalus.Methods:Through the medical record system,the a SAH patients admitted to Qingdao Municipal Hospital from January 2015 to June 2022 were searched,and the data of patients with endovascular interventional therapy were screened out.The clinical and imaging data such as age,gender,body mass index(BMI),hypertension,diabetes,onset-hospitalization time,preoperative systolic blood pressure,preoperative diastolic blood pressure,surgical side,responsible aneurysm location,aneurysm diameter,Hunt-Hess grade,Glasgow Coma Score(GCS),modified Fisher grade,SEBES,postoperative lumbar puncture times,postoperative eye opening time and related laboratory test results at admission were retrospectively analyzed.According to whether subacute hydrocephalus occurred after operation,they were divided into two groups : no subacute hydrocephalus and subacute hydrocephalus.The included indexes were first analyzed by single factor analysis to screen out statistically significant factors.Then it was included in multivariate logistic regression analysis to determine the independent risk factors affecting the occurrence of subacute hydrocephalus.The receiver operating characteristic(ROC)curve was drawn by statistical software and the areas under the ROC curve(AUC)were calculated to evaluate the predictive ability of risk factors for subacute hydrocephalus.Results:(1)Univariate analysis results : There were significant differences in age,hypertension,Hunt-Hess grade,GCS score,modified Fisher grade,SEBES,preoperative systolic blood pressure,preoperative diastolic blood pressure,aneurysm diameter,postoperative lumbar puncture times,HGB,GLU and RDW between the two groups(P <0.05).It shows that the above factors are related to the occurrence of postoperative subacute hydrocephalus.(2)Multivariate analysis results : The meaningful factors of univariate analysis were included in multivariate analysis.Hypertension(P = 0.010,OR = 6.617,95 % CI =1.435-4.557),Hunt-Hess grade(P = 0.001,OR = 10.293,95 % CI = 1.641-3.571),GCS score(P = 0.038,OR = 4.289,95 % CI = 0.777-0.867),modified Fisher grade(P = 0.003,OR = 8.863,95 % CI = 1.326-2.284),SEBES score(P = 0.020,OR = 5.381,95 % CI =1.132-2.229),RDW(P = 0.001,OR = 10.234,95 % CI = 1.115-1.325),postoperative lumbar puncture times(P = 0.049,OR = 3.873,95 % CI = 1.0066-3.15).The above factors are independent risk factors for postoperative subacute hydrocephalus.(3)Drawing ROC and the area under the ROC curve : the prognostic efficacy of each factor in predicting the occurrence of subacute hydrocephalus from large to small is : the AUC of ‘ joint detection ‘ is 0.944(0.906,0.982)(P < 0.001),the specificity is 0.928,the sensitivity is 0.877,and the Youden index is 0.805.The AUC of Hunt-Hess classification was 0.817(0.757,0.877)(P < 0.001),the specificity was 0.868,the sensitivity was 0.615,and the Youden index was 0.483.The AUC of SEBES was 0.813(0.747,0.879)(P <0.001),the specificity was 0.743,the sensitivity was 0.831,and the Youden index was0.574.The AUC of RDW was 0.751(0.676,0.827)(P < 0.001),the specificity was 0.868,the sensitivity was 0.585,the Youden index was 0.453,and the best cutoff value was 44.95.The AUC of hypertension was 0.748(0.678,0.817)(P < 0.001),the specificity was0.664,the sensitivity was 0.831,and the Youden index was 0.495.The AUC of GCS score was 0.739(0.667,0.812)(P < 0.001),the specificity was 0.711,the sensitivity was 0.754,the Youden index was 0.465,and the best cutoff value was 9.The AUC of the modified Fisher classification was 0.734(0.655,0.814)(P < 0.001),the specificity was 0.789,the sensitivity was 0.677,and the Youden index was 0.466.The AUC of the number of lumbar punctures after surgery was 0.625(0.544,0.705)(P = 0.004),and the specificity was0.625(0.544,0.705)(P = 0.004).Conclusion:(1)The age,hypertension,preoperative systolic blood pressure,preoperative diastolic blood pressure,aneurysm diameter,HGB,GLU,RDW,Hunt-Hess grade,GCS score,modified Fisher grade,SEBES and postoperative lumbar puncture times(< 5 times)of a SAH patients were correlated with postoperative subacute hydrocephalus.(2)Hypertension,Hunt-Hess grade,modified Fisher grade,GCS score,SEBES score,RDW,postoperative lumbar puncture times(< 5 times)are independent risk factors for subacute hydrocephalus after endovascular interventional therapy,which may have predictive value.The combined detection of 7 independent risk factors has a better predictive effect on subacute hydrocephalus after a SAH than any single risk factor.