关键词: 颅脑损伤, 脑积水, 意识障碍, 危险因素, 列线图, 脑室腹膜分流术

Abstract: Objective To investigate the risk factors for the prognosis of ventriculoperitoneal shunt in patients with post-traumatic hydrocephalus complicated with severe disturbance of consciousness, and to construct a linear prediction model to guide the early identification of high-risk patients. Methods Patients diagnosed with post-traumatic hydrocephalus complicated with severe disturbance of consciousness in our hospital were selected as research objects. All patients were treated with ventriculoperitoneal shunt. Three months after treatment, patients were divided into the good prognosis group (GOS score ＞ 3 points) and the poor prognosis group (GOS score ≤3 points). Multivariate Logistic regression was used to screen risk factors, and a nomogram prediction model was built on this basis. The receiver operating characteristic (ROC) curve, area under curve (AUC) and Hosmer-Lemeshow test were used to evaluate the model. Results A total of 218 patients were included in the analysis, including 153 in the model group and 65 in the validation group. In the model group, 90 cases (58.8%) had a good prognosis, and 63 cases (41.2%) had a poor prognosis. Multivariate Logistic regression analysis showed that age ≥50 years (OR=1.356, 95%CI: 1.101-1.639), moderate hydrocephalus (OR=2.859, 95%CI: 2.325-3.212), Glasgow coma score 9-12 points at onset (OR=2.421, 95%CI: 2.056-2.857) and interval from onset to shunt≥3 months (OR=1.639, 95%CI: 1.325-2.124) were independent risk factors affecting prognosis (all P＜0.05). According to the above factors, the AUC of clinical prognosis were 0.896 (95%CI: 0.842-0.933) and 0.875 (95%CI: 0.825- 0.916) in the model group and the validation group respectively (P＜0.05). Hosmer-Lemeshow test showed that there was a good fitting degree for the line graph model (χ2=0.896 in the model group, χ2=0.567 in the verification group, both P＜ 0.05). After risk stratification based on the line graph model, the proportion of poor prognosis was significantly higher in high and medium risk patients than that of the low risk patients in the model group and the validation group. Conclusion The model constructed in this study has a high value in evaluating patients with post-traumatic hydrocephalus and severe disturbance of consciousness undergoing ventriculoperitoneal shunt, and which can guide the early clinical identification of high-risk patients.

Key words: craniocerebral trauma, hydrocephalus, consciousness disorders, risk factors, nomograms, ventriculoperitoneal shunt