A New Inflammatory Parameter Can Predict Delayed Intracranial Hemorrhage Following Ventriculoperitoneal Shunt

Abstract

Background: Delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is considered to be a potentially severe event, however, little is known about the risk factors and underlying mechanisms. This study aimed to investigate the association between NLRR (a ratio of postoperative neutrophil-to-lymphocyte ratio to preoperative neutrophil-to-lymphocyte ratio) and DICH secondary to VP shunt.Methods: 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.Results: A total of 130 patients were enrolled and DICH occurred in 29 patients. Elevated NLRR (odds ratio [OR], 2.774; 95% confidence interval [CI], 1.372-5.609; P<0.001) and history of craniotomy (OR, 3.505; 95%CI, 1.040-11.813; p=0.043) were independent risk factors for DICH secondary to VP shunt. Receiver operating characteristic curve analysis of NLRR showed that area under the curve was 0.832. 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 (OR, 11.25; 95%CI, 1.35-93.50; p=0.025; PSM cohort, n=82). Conclusions: 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.