Total iron and Fe2+ concentration in cerebrospinal fluid are strongly correlated with the incidence of hydrocephalus in intracerebral hemorrhage patients with intraventricular extension

Hydrocephalus is a known complication of spontaneous intracerebral hemorrhage (ICH) extending into the cerebral ventricles (Intraventricular Hemorrhage, IVH) and is associated with poorer patient outcomes. Accurately predicting the risk of shunt-dependent hydrocephalus could help anticipate the need for permanent CSF diversion in these patients and improve outcomes. Based on the suspected molecular pathogenesis of hydrocephalus, certain biomarkers may be reliable predictors of shunt-dependent hydrocephalus in ICH + IVH patients. This study aimed to test the reliability of Fe 2+ , Fe 3+ , total iron concentration, and high mobility group box 1 (HMGB1) protein levels in the cerebrospinal fluid to predict the risk of shunt-dependent hydrocephalus in patients with ICH + IVH. This prospective cohort study included all adult ICH + IVH patients with hydrocephalus admitted to Siloam Hospitals Lippo Village between March 2021 and December 2023. Patient demographics, radiological characteristics, and CSF samples were analyzed to evaluate the clinical, radiological, and molecular parameters associated with the risk of shunt-dependent hydrocephalus. Thirty-six patients were included. Seventeen patients (47.2 %) developed shunt-dependent hydrocephalus. Analysis showed that increased total Fe ( p = 0.048) and Fe 2+ ( p = 0.045) concentrations were significantly associated with the incidence of hydrocephalus. The AUCs of total iron (0.716), Fe 2+ (0.758), Fe 3+ (0.651), and HMGB1 (0.722) were higher than that of the mGraeb score (0.528) in predicting shunt-dependent hydrocephalus. CSF total iron and Fe 2+ levels are reliable predictors of hydrocephalus in patients with ICH + IVH. These biomarkers are more sensitive and specific in predicting shunt-dependent hydrocephalus compared to the mGraeb score.