Negative predictors of shunt surgery outcome in normal pressure hydrocephalus
Negative predictors of shunt surgery outcome in normal pressure hydrocephalus
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DOI：
10.1111/ane.13200
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发表时间：
2019-12-13
影响因子：
3.5
通讯作者：
Virhammar, Johan
中科院分区：
文献类型：
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作者：
Badagard, Henrik;Braun, Madelene;Virhammar, Johan
目的特发性常压性脑积水(INPH)和血管并发症的患病率随着年龄的增长而增加。目前还不清楚高龄和血管疾病是否是INPH患者分流手术结果的负面预测因素。本研究的目的是调查高龄和血管并发症对INPH患者分流术后预后的影响。方法连续纳入2011-2015年间在同一中心接受分流术治疗的332例INPH患者。术前和术后12个月随访时计算Hellstrom INPH评分，不做神经心理测试。结果被定义为手术后和手术前INPH量表评分的差值。采用多变量模型研究年龄和血管并发症对分流术结果的预测作用。结果在以术后预后为因变量的多因素协方差分析(ANCOVA)中，年龄(年龄，B=-0.63，P&t；.001)和缺血性卒中病史(B=-10.06，P=.0038)是影响分流术疗效的负因素。结论高龄和既往脑血管疾病与INPH患者分流术后预后不良有关。
Objectives The prevalence of idiopathic normal pressure hydrocephalus (iNPH) and vascular comorbidity increases with age. It has not been clarified if high age and vascular disease are negative predictors of shunt surgery outcome in patients with iNPH. The aim of this study was to investigate the impact of high age and vascular comorbidity on outcome after shunt surgery in patients with iNPH. Methods All 332 patients with iNPH who were treated with shunts between 2011 and 2015 at a single centre were consecutively included. Hellstrom iNPH scale, without the neuropsychological tests, was calculated preoperatively and at follow-up 12 months after shunt surgery. Outcome was defined as the difference between the post-operative and preoperative iNPH scale scores. A multivariable model was used to investigate the predictive effects of age and vascular comorbidity on shunt surgery outcome. Results In a multivariable analysis of covariance (ANCOVA) with post-operative outcome as the dependent variable, increasing age (years, B = -0.63, P < .001) and history of ischaemic stroke (B = -10.06, P = .0038) were negative predictors of shunt surgery outcome after controlling for waiting time for surgery, symptom severity at preoperative control, presence of diabetes mellitus, hypertension, hyperlipidaemia, history of myocardial infarction, duration of symptoms and shunt complications. Conclusions High age and established cerebrovascular disease are associated with less favourable outcome after shunt surgery in patients with iNPH.