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Long-term Outcomes and Risk Factors Related to Hydrocephalus After Intracerebral Hemorrhage

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Abstract

Hydrocephalus after intracerebral hemorrhage (ICH) is a common and treatable complication. However, the long-term outcomes and factors for predicting hydrocephalus have seldom been studied. The goal of this study was to determine the long-term outcomes and analyze the risk factors of hydrocephalus after ICH. A consecutive series of 1342 patients with ICH were reviewed from 2010 to 2016 to identify significant risk factors for hydrocephalus. Patients with a first-ever ICH without any prior diagnosis of hydrocephalus after ICH were followed up for survival status and cause of death. Risk factors for hydrocephalus were evaluated by using logistic regression analysis. Out of a total of 1342 ICH patients, 120 patients (8.9%) had hydrocephalus. The risk factors for hydrocephalus (≤ 3 days) were infratentorial hemorrhage (p = 0.000), extension to ventricles (p = 0.000), greater ICH volume (p = 0.09), and hematoma expansion (p = 0.01). Extension to ventricles (p = 0.022) was the only independent risk factor for hydrocephalus (4–13 days), while extension to ventricles (p = 0.028), decompressive craniotomy (p = 0.032), and intracranial infection (p = 0.001) were independent predictors of hydrocephalus (≥ 14 days). Patients were followed up for a median of 5.2 years (IQR 3.3–7.3 years). Estimated all-cause mortality was significantly higher in the ICH patients with hydrocephalus than that without hydrocephalus (HR 3.22, 95% CI 2.42–4.28; p = 0.000). Fifty-nine (49.2%) died and 40 (33.3%) had a favorable outcome in patients with hydrocephalus. Of all deaths, 30.5% were from ICH and 64.4% from infection. Hydrocephalus is a frequent complication of ICH and most commonly occurs at the onset of ICH. Patients with hydrocephalus show relatively higher mortality. ClinicalTrials.gov Identifier: NCT02135783 (May 7, 2014)

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Acknowledgments

We thank the participants included in our trial for their involvement and enthusiasm.

Funding

This work was supported by the National Key Research and Development Program of China (No. 2017YFC0111900) and National Natural Science Foundation of China (No. 81671228).

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Authors and Affiliations

  1. Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan, Shapingba District, Chongqing, 400038, China

    Rong Hu, Chao Zhang, Jiesheng Xia, Hongfei Ge, Jun Zhong, Xuanyu Fang, Yongjie Zou, Chuan Lan, Lan Li & Hua Feng

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  1. Rong Hu
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  10. Hua Feng
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Contributions

RH and FH conceived, organized and supervised the study. CZ, JSX, HFG, JZ, and YJZ, CL and LL conducted the research. RH and XYF performed the statistical analysis. RH and CZ prepared and revised the manuscript. All authors approved the final version to be published.

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Correspondence to Rong Hu or Hua Feng.

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All inferences, opinions, and conclusions drawn in this publication are those of the authors and do not reflect the opinions or policies of the data steward(s).

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This study adheres to the principles of the Declaration of Helsinki. The protocol was approved by the Ethics Committee of the Southwest Hospital of Third Military Medical University, China.

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Hu, R., Zhang, C., Xia, J. et al. Long-term Outcomes and Risk Factors Related to Hydrocephalus After Intracerebral Hemorrhage. Transl. Stroke Res. 12, 31–38 (2021). https://doi.org/10.1007/s12975-020-00823-y

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