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

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.

Delayed Intracerebral Hematoma after Ventriculoperitoneal Shunt in the Context of Ruptured Brain Arteriovenous Malformation: A Literature Review

“…The most widely accepted hypothesis suggests a progressive vascular erosion and inflammatory vasculitis reaction resulting from the close contact between the catheter and the brain vessels, potentially in the context of a degenerative brain parenchymal disease [ 10 , 14 , 25 , 27 ]. A recent study identified an inflammatory parameter, the neutrophil-to-lymphocyte ratio, as a successful predictor of DICH following VPS, with an incidence of 40.6% in the identified subgroup, indicating the potential involvement of inflammatory pathways [ 33 ]. In a relevant series of 20 patients, Guo et al identified statistically significant independent risk factors for DICH, including age, history of craniotomy, and radiological features on initial CT scans [ 9 ].…”

Risk factors for delayed intracranial hemorrhage secondary to ventriculoperitoneal shunt: A retrospective study

“…In our study, the incidence of DICH was 16.4%, which corresponded to the incidence range of previous studies. The wide range of incidence may be related to the neglect of minor hematoma volume, lower frequency of postoperative CT scan examinations, and different inclusion and exclusion criteria in different studies[ 6 , 19 ]. We suppose that the real incidence range of DICH will be more accurate with careful surveillance, such as imaging and unified standards, in the future.…”

“…Delayed intracranial hemorrhage (DICH) refers to a subsequent cerebral hemorrhage that was not found in the first postoperative computed tomography (CT) scan of the VP shunt. Compared with other complications, DICH was regarded as a rare complication of VP shunts[ 5 , 6 ]. In 1985, Matsumura et al [ 7 ] provided a case report that was the first to describe DICH[ 7 ].…”