Association of erythrocyte counts in cerebrospinal fluid with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

Abstract

Abstract Objective Shunt-dependent hydrocephalus (SDH) is one of the common complications of aneurysmal subarachnoid hemorrhage(aSAH). Several risk factors have been reported to predict the occurrence of SDHC in patients with aSAH. However, few studies have concentrated erythrocyte count in the cerebrospinal fluid (CSF). This study aimed to investigate the association of erythrocyte count in CSF with the occurrence of SDHC following aSAH. Methods We retrospectively analyzed the CSF data of patients with aSAH within 7 days of onset in our hospital from December 2017 to April 2021. The difference of erythrocyte counts in CSF between the SDH group and the non-SDH group was examined within 7 days of onset. The effect of erythrocyte count on SDH was analyzed, and the cutoff value was determined using the receiver operating characteristic (ROC) curve analysis. Grouping was carried out based on the cutoff value, and statistical analysis was employed to compare the statistical significance between the two groups. The erythrocyte count was utilized as a risk factor, along with other factors, to predict the occurrence of SDHC following aSAH. Results It was attempted to enroll 424 patients with aneurysms and 31 (7.3%) patients who underwent ventriculoperitoneal shunt (VPS) after aneurysm treatment. The differences in erythrocyte count were compared between the SDHC group and the non-SDHC group. The predictive effect of erythrocyte count on the SDHC was determined by ROC curves on D3, D4, D5, D6, and D7. The results of ROC curve analysis revealed that the erythrocyte count was significant different on D3 and D6 between the two groups. It was also found that the cutoff values of erythrocyte count on D3 and D6 were 73000 and 120000 10^/L, respectively. The erythrocyte counts on D3 and D6 was divided into two groups based on the cutoff value for making comparison. On D3, the incidence of aSAH in ≥ 73000 (10^/L) group (13.6%) was nearly 10 times that of < 73000 (10^/L) group (1.3%). Similarly, on D6, the incidence in ≥ 120000 (10^/L) group (44.4%) was nearly 10 times that of < 120000 (10^/L) group (4.2%). The erythrocyte count in CSF was utilized as a risk factor, in combination with intraventricular hemorrhage and acute hydrocephalus, to examine the predictive efficacy using the ROC curve analysis. The results indicated that the area under the curve value for the erythrocyte count was 0.814 (P = 0.001) when combined with intraventricular hemorrhage and acute hydrocephalus curves on D6. Conclusion The erythrocyte count was found as an independent risk factor for SDHC in patients with aSAH. The erythrocyte counts in the CSF on D6 and D3 ware determined by the cutoff value. The findings may assist the future research on the accurately prediction of the occurrence of SDHC following aSAH.