Influencing factors and risk prediction model for patients with aneurysmal subarachnoid hemorrhage complicated with hydrocephalus

SHAO Zhengqun; WANG Yao; LU Hua; LI Zheng; CHEN Hui; CHANG Hanxiao

Abstract：Objective To explore the influencing factors of hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH) and establish a risk prediction model. Methods A total of 130 patients with aSAH admitted to the First Affiliated Hospital of Nanjing Medical University from July 2021 to June 2024 were selected as the study subjects. After 3 months of follow-up,they were divided into hydrocephalus group (n=38) and non-hydrocephalus group (n=92) according to the occurrence of hydrocephalus. The influencing factors of hydrocephalus in aSAH patients were explored by Binary Logistic stepwise regression analysis,and the nomogram model was constructed. The predictive value of the nomogram model in patients with aSAH complicated with hydrocephalus was evaluated by ROC. Results In hydrocephalus group,the proportion of age≥60 years old,diabetes history,GCS score<9,Hunt-Hess grade Ⅲ-Ⅳ,Fisher grade Ⅲ-Ⅳ,intracerebral hemorrhage into ventricle,external ventricular drainage and intracranial infection were higher than those in non-hydrocephalus group. D-dimer,CSF pressure,CSF protein content and RBC level were higher than those in non-hydrocephalus group,and CSF glucose content was lower than those in non-hydrocephalus group (P<0.05). Age≥60 years old (OR=1.806,95％CI:1.327-2.456),Hunt-Hess classification (Ⅲ-Ⅳ) (OR=1.846,95％CI:1.354-2.516),intracranial hemorrhage into the ventricle (OR=3.019,95％CI:1.939-4.702),intracranial infection (OR=2.581,95％CI:1.717-3.879),and elevated D-dimer level (OR=2.550,95％CI:1.693-3.841),increased RBC levels in CSF (OR=2.487,95％CI:1.657-3.731),and low glucose levels in CSF (OR=0.416,95％ CI:0.279-0.621) were independent risk factors for hydrocephalus in aSAH patients (P<0.05). A nomogram model was thus constructed to predict hydrocephalus in aSAH patients,and the results showed that the C-index was 0.812 (95％CI:0.761-0.863). The area under the curve (AUC) of aSAH patients with hydrocephalus was 0.879 (95％CI:0.826-0.932),the specificity was 67.44％,and the sensitivity was 91.15％. Conclusions The risk factors of hydrocephalus in aSAH patients include age,Hunt-Hess grade,intracranial infection,D-dimer,RBC of CSF and glucose content of CSF. The histogram model constructed on this analysis has good predictive value for hydrocephalus in aSAH patients.