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Cerebrospinal fluid predictors of shunt-dependent hydrocephalus after hemorrhagic stroke: a systematic review and
Yao-Chung Yang1,2, Szu-Hao Liu1, Yu-Hone Hsu1
1Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Insights
Higher protein, TGF-β1, and ferritin in cerebrospinal fluid (CSF) predict shunt-dependent hydrocephalus (SDHC) after hemorrhagic stroke. These CSF markers aid early SDHC risk identification in stroke patients.
Area of Science:
- Neurology
- Neurosurgery
- Clinical Diagnostics
Background:
- Hydrocephalus is a frequent complication of hemorrhagic stroke, often leading to poor neurological outcomes.
- Identifying patients at risk for shunt-dependent hydrocephalus (SDHC) is crucial for timely intervention.
Purpose of the Study:
- To evaluate the predictive value of cerebrospinal fluid (CSF) parameters for the development of SDHC in patients following hemorrhagic stroke.
Main Methods:
- A systematic review and meta-analysis of 16 studies involving 1505 patients was conducted.
- Studies were identified through PubMed, CENTRAL, and Embase databases up to July 31, 2021.
- Study quality was assessed using the Newcastle-Ottawa Scale.
Main Results:
- Elevated CSF protein levels (MD = 32.09 mg/dL), transforming growth factor β1 (TGF-β1) (MD = 0.52 ng/mL), and ferritin (MD = 108.87 µg/dL) were significant predictors of SDHC.
- CSF red blood cell count, lactate, and glucose levels did not significantly predict SDHC.
- High homogeneity was observed for protein and TGF-β1 predictors (I² = 0%).
Conclusions:
- Higher CSF protein, TGF-β1, and ferritin levels are significant predictors of SDHC in hemorrhagic stroke patients.
- Measuring these CSF biomarkers can facilitate early detection of SDHC risk.
- This finding supports the clinical utility of CSF analysis for managing post-hemorrhagic stroke complications.
Abstract:
Hydrocephalus is a common complication of hemorrhagic stroke and has been reported to contribute to poor neurological outcomes. Herein, we aimed to investigate the validity of cerebrospinal fluid (CSF) data in predicting shunt-dependent hydrocephalus (SDHC) in patients with hemorrhagic stroke. PubMed, CENTRAL, and Embase databases were searched for relevant studies published through July 31, 2021. The 16 studies with 1505 patient included those in which CSF data predicted risk for SDHC and reports on CSF parameters in patients in whom SDHC or hydrocephalus that was not shunt-dependent developed following hemorrhagic stroke. We appraised the study quality using Newcastle-Ottawa Scale and conducted a meta-analysis of the pooled estimates of the CSF predictors. The meta-analysis revealed three significant CSF predictors for shunt dependency, i.e., higher protein levels (mean difference [MD] = 32.09 mg/dL, 95% confidence interval [CI] = 25.48-38.70, I2 = 0%), higher levels of transforming growth factor β1 (TGF-β1; MD = 0.52 ng/mL, 95% CI = 0.42-0.62, I2 = 0%), and higher ferritin levels (MD = 108.87 µg/dL, 95% CI = 56.68-161.16, I2 = 36%). The red blood cell count, lactate level, and glucose level in CSF were not significant in predicting SDHC in patients with hemorrhagic stroke. Therefore, higher protein, TGF-β1, and ferritin levels in CSF are significant predictors for SDHC in patients with hemorrhagic stroke. Measuring these CSF parameters would help in the early recognition of SDHC risk in clinical care.
