title: The relationship between risk factors and prognostic factors in patients with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  We investigated the predictors and outcomes of aneurysmal subarachnoid hemorrhage in patients with shunt-dependent hydrocephalus and make a preliminary inquiry into the relationship between the two.
  
  
  METHODS
  A consecutive cohort of 202 patients was evaluated, which included 40 shunt-dependent hydrocephalus patients. The basic characteristics on admission, complications of hemorrhage, management before onset of chronic hydrocephalus, and outcomes of shunting were established. The Glasgow Outcome Scale score was used to evaluate the recovery of patients with a ventriculoperitoneal (V-P) shunt. Furthermore, relevant statistical analyses were presented to identify the significance of risk factors and prognostic factors associated with shunt-dependent hydrocephalus.
  
  
  RESULTS
  From among 202 patients, 40 (19.8%) developed shunt-dependent hydrocephalus, and 26 (65.0%) of these 40 improved after undergoing a V-P shunt. In the univariate analysis, age, preexisting hypertension, Glasgow Coma Scale score, Hunt-Hess grade, modified Fisher grade, posterior circulation, rebleeding, acute hydrocephalus, intraventricular hemorrhage, vasospasm, nosocomial meningitis, neurosurgical clipping, decompressive craniectomy, external ventricular drainage (EVD), and duration of EVD were significantly related to shunt-dependent hydrocephalus; moreover, age, preexisting hypertension, posterior circulation, acute hydrocephalus, intraventricular hemorrhage, and decompressive craniectomy were independent predictors. Similarly, age, Hunt-Hess grade, Glasgow Coma Scale score, nosocomial meningitis, and duration of EVD could be the prognosticators of a V-P shunt.
  
  
  CONCLUSIONS
  Patients who were older, with worse mental function status on admission, nosocomial meningitis, and longer duration of EVD, are susceptible to shunt-dependent hydrocephalus because of ruptured intracranial aneurysm and also have unfavorable outcomes after a V-P shunt. Timely and appropriate treatment can benefit such patients in recovery.
authors.affiliation: From the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Yu
authors.forename: Renya
authors.initials: R
authors.lastname: Zhan
authors.forename: Liang
authors.initials: L
authors.lastname: Wen
authors.forename: Jian
authors.initials: J
authors.lastname: Shen
authors.forename: Zuoxu
authors.initials: Z
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003428:Cross Infection; D004322:Drainage / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology*; D007223:Infant; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D017287:Ventriculoperitoneal Shunt; D055815:Young Adult