Co-morbidity as a predictor of outcome in patients with idiopathic normal-pressure hydrocephalus.
BACKGROUND
A critical question in the diagnosis and treatment of idiopathic normal-pressure hydrocephalus (iNPH) is which preoperative factors can most reliably predict outcomes following shunt insertion. The number and type of co-morbidities are increasingly being viewed as important predictive indicators.


METHODS
Between 1997 and 2005, 100 patients were implanted with a gravitational ventriculo-peritoneal shunt as a treatment for iNPH. All coincident disease processes were recorded. Eighty-two of these patients underwent follow-up of 2 years post-operation. The results of this prospective follow-up examination (Kiefer Score, NPH Recovery Rate) were compared with the preoperative Co-morbidity Index (CMI).


RESULTS
Of the patients with a CMI score of 0-1 (n = 18), 67% experienced an excellent outcome, 28% a good outcome, and 5% and 0% fair and poor outcomes, respectively. A CMI score of 2-3 was associated with markedly poorer outcomes (n = 33); 42% excellent, 30% good, 18% fair and 10% poor. A score of 4-5 was related to 14% excellent, 27% good, 23% fair and 36% poor outcomes (n = 22). Remarkably, a few patients scoring between 6 and 8 on the CMI scale experienced a favorable outcome. The outcomes for this latter group were 0% excellent, 10% good, 45% fair and 45% poor (n = 9).


CONCLUSIONS
Co-morbidity is a statistically significant predictor of the quality of clinical outcome for patients with iNPH undergoing shunt therapy.
Meier
Ullrich
U
Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany. ullrich.meier@ukb.de
Lemcke
Johannes
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*