Associated Factors and Outcomes of Patients With Intracerebral Hemorrhage After Permanent Cerebrospinal Fluid Shunt Placement

BACKGROUND AND OBJECTIVES: Intraventricular hemorrhage (IVH) occurs in 30% to 50% of intracerebral hemorrhage (ICH) cases and frequently requires permanent cerebrospinal fluid (CSF) shunting. This study aims to identify factors associated with permanent CSF shunt and its related outcomes. METHODS: A retrospective analysis of prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study was conducted. Factors associated with permanent CSF shunting were assessed using univariable and bidirectional stepwise logistic regression models. Patients were dichotomized based on permanent CSF shunting and propensity score-matched 1:1. The primary outcome was 3-month mortality. Secondary outcomes included in-hospital mortality; 3-, 6-, and 12-month modified Rankin Scale; EuroQoL Group 5-dimension self-report questionnaire; and Barthel Index. RESULTS: Among 2995 patients with ICH (median age 61 years, IQR 51-73), 141 (4.7%) underwent permanent CSF shunting. Factors independently associated with permanent shunting included younger age (odds ratio [OR] = 0.96 [0.95-0.98]), previous antiplatelet (OR = 1.61 [1.08-2.42]) or anticoagulant use (OR = 2.41 [1.28-4.53]), lower admission Glasgow Coma Scale (OR = 0.90 [0.86-0.94]), thalamic hemorrhage (OR = 1.59 [1.06-2.39]), and concomitant IVH (OR = 5.64 [3.38-9.39]). After 1:1 propensity matching (n = 124 per group), 3-month mortality was lower in the permanent CSF shunt group (OR = 0.32 [0.17-0.59]). Ambulatory independence and Barthel Index scores were significantly worse at 3 and 6 months after shunt placement. The odds of incontinence at 3 months were higher among this group (OR = 3.30 [1.58-6.87]). By 12 months, functional outcomes were comparable between groups. CONCLUSION: Younger age, antiplatelet or anticoagulant use, lower admission Glasgow Coma Scale, thalamic hemorrhage, and concomitant IVH are independently associated with shunt dependency in patients with ICH. Permanent CSF shunting was associated with a 60% reduction in 3-month mortality. Although early functional outcomes were worse among shunted patients, overall functional status was comparable by 12 months. Permanent CSF shunting may offer survival benefits, highlighting the need to determine the optimal timing for placement and rehabilitation programs following the procedure.