Predicting Shunt Dependency from the Effect of Cerebrospinal Fluid Drainage on Ventricular Size.
Predicting Shunt Dependency from the Effect of Cerebrospinal Fluid Drainage on Ventricular Size.
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DOI：
10.1007/s12028-022-01538-8
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发表时间：
2022-12
影响因子：
3.5
通讯作者：
中科院分区：
文献类型：
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蛛网膜下腔出血 (SAH) 患者长期脑室外引流 (EVD) 会导致发病，而早期切除也会产生与复发性脑积水相关的不良影响。帮助确定移除 EVD 或放置脑室腹腔分流术 (VPS) 的最佳时间的指标将有助于防止长期不必要地使用 EVD。本研究旨在确定脑脊液 (CSF) 生物识别动态是否可以暂时预测 SAH 后的 VPS 依赖性。对动脉瘤性蛛网膜下腔出血患者进行的一项前瞻性单中心观察性研究的回顾性分析，该研究需要放置 EVD 来治疗脑积水。患者被分为 VPS 依赖性 (VPS+) 和非 VPS 依赖性 (VPS−) 组。我们测量了所有可用的计算机断层扫描的双尾状指数（BCI），并计算了随时间的变化（BCI 增量）。我们使用 Pearson 相关性分析了 BCI 增量与 CSF 输出的关系。计算 Delta BCI 和 CSF 输出之间关系的 k 最近邻模型来对 VPS 进行分类。五十八名患者符合纳入标准。 EVD 放置后 7 天，VPS+ 组的 CSF 输出显着更高。从 EVD 放置后第四天到第六天开始，VPS+ 组的 delta BCI 和 CSF 输出呈正相关，而 VPS− 组则呈负相关（p<0.05）。用于分类的加权 k 最近邻模型的敏感性为 0.75，特异性为 0.70，受试者工作特征曲线下面积为 0.80。早在 EVD 放置后四到六天，BCI 和 CSF 输出增量的相关性是 SAH 后 VPS 依赖的可靠个体内生物特征。我们的机器学习模型利用 delta BCI 和累积 CSF 输出之间的关系来预测 VPS 依赖性。可以研究 VPS 依赖性的早期知识，以减少埃博拉病毒病的持续时间，并在许多中心缩短重症监护室的住院时间。
Prolonged external ventricular drainage (EVD) in patients with subarachnoid hemorrhage (SAH) leads to morbidity, while early removal can also have untoward effects related to recurrent hydrocephalus. A metric to help determine the optimal time for EVD removal or ventriculoperitoneal shunt (VPS) placement would be beneficial in preventing prolonged unnecessary use of EVD. This study aimed to identify if dynamics of cerebral spinal fluid (CSF) biometrics can temporally predict VPS dependency after SAH. Retrospective analysis of a prospective single-center observational study of patients with aneurysmal SAH, that required EVD placement for hydrocephalus. Patients were divided into VPS dependent (VPS+) and non-VPS dependent (VPS−) groups. We measured the bicaudate index (BCI) on all available computed tomography scans, and calculated the change over time (delta BCI). We analysed the relationship of delta BCI with CSF output using Pearson’s correlation. A k-nearest neighbor model of the relationship between delta BCI and CSF output was computed to classify VPS. Fifty-eight patients met inclusion criteria. CSF output was significantly higher in the VPS+ group in the 7 days post EVD placement. There was a positive correlation between delta BCI and CSF output in the VPS+ group and a negative correlation in the VPS− group starting from days four to six after EVD placement (p<0.05). A weighted k-nearest neighbor model for classification had a sensitivity of 0.75, a specificity of 0.70, and an area under the receiver operating characteristic curve of 0.80. The correlation of delta BCI and CSF output is a reliable intra-individual biometric for VPS dependency after SAH as early as days four to six after EVD placement. Our machine learning model leverages this relationship between delta BCI and cumulative CSF output to predict VPS dependency. Early knowledge of VPS dependency could be studied to reduce EVD duration and in many centers, intensive care unit length of stay.
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影响因子：
2.4
作者：
Czorlich, Patrick;Ricklefs, Franz;Schmidt, Nils Ole
通讯作者：
Schmidt, Nils Ole
影响因子：
4.1
作者：
Klopfenstein, JD;Kim, LJ;Spetzler, RF
通讯作者：
Spetzler, RF
影响因子：
4.1
作者：
Garcia, Sergio;Torne, Ramon;Ensenat, Joaquim
通讯作者：
Ensenat, Joaquim
影响因子：
8.3
作者：
Adams, Hadie;Ban, Vin Shen;Huttunen, Terhi J.
通讯作者：
Huttunen, Terhi J.
影响因子：
4.8
作者：
Little, Andrew S.;Zabramski, Joseph M.;Spetzler, Robert F.
通讯作者：
Spetzler, Robert F.