176 Predictors and Outcomes of Patients With Intracerebral Hemorrhage Following Permanent CSF Shunt Placement

INTRODUCTION: Intraventricular hemorrhage (IVH) occurs in 30-50% of patients with intracerebral hemorrhage (ICH) and may be associated with acute hydrocephalus. A subset of patients require external ventricular drainage of cerebrospinal fluid (CSF) and subsequent permanent shunting. METHODS: Prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study was analyzed. Predictors of permanent CSF shunting were assessed using univariable and stepwise backward logistic regression models. Patients were dichotomized based on permanent CSF shunting and then propensity score matched in a 1:1 ratio. Outcomes of interest were mortality at discharge, modified Rankin Scale (mRS), EuroQoL Group 5-Dimension self-report questionnaire (EQ-5D), and Barthel Index scores at 3, 6, and 12 months. RESULTS: 2995 ICH patients were included. Median age at presentation was 61 years (IQR 51-73). A permanent CSF shunt was placed in 141 patients (4.7%). Independent predictors of permanent shunting were past ICH (OR=3.81 [1.14-12.75], antiplatelet medication before ICH (OR=2.31 [1.13-4.74]), lower GCS at admission (OR=0.84 [0.78-0.91]), thalamic location (OR=2.06 [1.03-4.12]), and concomitant IVH (OR=7.15 [2.84-17.97]). Overall discharge mortality was 11.1%, with a comparable risk between groups (OR=0.87 [0.49-1.53]). Patients with a permanent CSF shunt were more likely to have worse mRS, EQ-5D, and Barthel Index scores at 3, 6, and 12 months. Matched cohorts comprised 138 patients each. Mortality at discharge was significantly lower for those undergoing permanent shunting (OR=0.40 [0.20-0.80]), and like the unmatched cohorts, their EQ-5D and Barthel Index scores were significantly worse. CONCLUSIONS: Past ICH, use of antiplatelets, low GCS at admission, thalamic location, and concomitant IVH significantly predict shunt dependency among ICH patients. The significantly increased morbidity among ICH survivors requiring permanent CSF shunting highlights the need to improve current treatments and recognize all the components involved in acute ICH inpatient care.