A sustained systemic inflammatory response syndrome is associated with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

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The authors sought to evaluate whether a sustained systemic inflammatory response was associated with shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage.


A retrospective analysis of 193 consecutive patients with aneurysmal subarachnoid hemorrhage was performed. Management of hydrocephalus followed a stepwise algorithm to determine the need for external CSF drainage and subsequent shunt placement. Systemic inflammatory response syndrome (SIRS) data were collected for all patients during the first 7 days of hospitalization. Patients who met the SIRS criteria every day for the first 7 days of hospitalization were considered as having a sustained SIRS. Univariate and multivariate regression analyses were used to determine predictors of shunt dependence.


Sixteen percent of patients required shunt placement. Sustained SIRS was observed in 35% of shunt-dependent patients compared to 14% in non–shunt-dependent patients (p = 0.004). On multivariate logistic regression, female sex (OR 0.35, 95% CI 0.142–0.885), moderate to severe vasospasm (OR 3.78, 95% CI 1.333–10.745), acute hydrocephalus (OR 21.39, 95% CI 2.260–202.417), and sustained SIRS (OR 2.94, 95% CI 1.125–7.689) were significantly associated with shunt dependence after aneurysmal subarachnoid hemorrhage. Receiver operating characteristic analysis revealed an area under the curve of 0.83 for the final regression model.


Sustained SIRS was a predictor of shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage even after adjustment for potential confounding variables in a multivariate logistic regression model.

ABBREVIATIONS AUC = area under the curve; CTA = CT angiography; DND = delayed neurological deficit; DSA = digital subtraction angiography; EVD = external ventricular drain; MFS = modified Fisher scale; NF = nuclear factor; ROC = receiver operating characteristic; SIRS = systemic inflammatory response syndrome; TGF = transforming growth factor; WFNS = World Federation of Neurosurgical Societies.

Article Information

Correspondence Aaron P. Wessell: University of Maryland School of Medicine, Baltimore, MD. awessell@som.umaryland.edu.

INCLUDE WHEN CITING Published online June 29, 2018; DOI: 10.3171/2018.1.JNS172925.

Disclosures Dr. Jindal reports receiving research grant funding from Stryker Neurovascular.

© AANS, except where prohibited by US copyright law.



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    Flow chart outlining patient selection criteria leading to 193 included study patients.

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    ROC curve for final regression model predicting shunt dependence (AUC = 0.8344). Figure is available in color online only.


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