Predictive value of serum AQP4 and Tau protein for postoperative hydrocephalus after decompressive craniectomy in patients with severe traumatic brain injury

ZHAO Jincheng; WANG Xing; LI Qichao; PENG Xiaohui; AN Minghua; WU Lei; WANG Yongheng

doi:10.3639/j.issn.1671-2897.2025.03.012

Abstract：Objective To explore the predictive value of serum aquaporin 4(Aquaporin 4,AQP4)and Tau protein for postoperative hydrocephalus after decompressive craniectomy in patients with severe traumatic brain injury.Methods 86 patients with severe traumatic brain injury admitted to the Neurosurgery Department of the First Hospital of Qinhuangdao from May 2021 to June 2024 were selected as the research subjects.All patients underwent decompressive craniectomy and were divided into non-hydrocephalus group(n=69)and hydrocephalus group(n=17)based on the occurrence of hydrocephalus one month after the surgery.Serum AQP4 and Tau protein were determined by ELISA and compared between these two groups.The predictive value of serum AQP4 and Tau protein for postoperative hydrocephalus after decompressive craniectomy in patients with severe traumatic brain injury was analyzed by ROC.The influencing factors of postoperative hydrocephalus after decompressive craniectomy in patients with severe traumatic brain injury were analyzed by multivariate Logistic stepwise regression.Results The levels of serum AQP4 and Tau protein in the hydrocephalus group were higher than those in the non-hydrocephalus group(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the combined prediction of serum AQP4 and Tau protein for postoperative hydrocephalus after decompressive craniectomy was 0.918,which was higher than that of the individual prediction of serum AQP4(0.791)and Tau protein(0.857)(Z=12.147,8.751,P<0.001).Univariate analysis showed that the GCS score of patients with hydrocephalus was lower than that of the non-hydrocephalus group at admission,and the time from injury to surgery,the proportion of postoperative intracranial infection,and the proportion of postoperative ventricular system bleeding were higher than those of the non-hydrocephalus group,with statistically significant differences(P<0.05).GCS score at admission(OR=2.208,95%CI:1.347-3.618),postoperative intracranial infection(OR=2.568,95%CI:1.589-4.150),postoperative ventricular system hemorrhage(OR=2.268,95%CI:1.315-3.911),AQP4(OR=2.927,95%CI:1.738-4.930),and Tau protein(OR=3.449,95%CI:1.950-6.100)were the influencing factors of postoperative hydrocephalus after decompressive craniectomy in patients with severe traumatic brain injury(P<0.05).Conclusions The occurrence of postoperative hydrocephalus after decompressive craniectomy in patients with severe traumatic brain injury is closely related to the increase of serum AQP4 and Tau protein.Serum AQP4 and Tau protein have certain predictive value for postoperative hydrocephalus after decompressive craniectomy in patients with severe traumatic brain injury,and the predictive efficacy of the combined detection is better.