Purpose

To assess the therapeutic efficacy of external ventricular draining (EVD) and to predict the need for permanent shunts in infants with postinfective hydrocephalus (PIHC).

Methods

This is a retrospective study of infants diagnosed with PIHC and treated by EVD between January 2013 and December 2017 at the Children’s Hospital of Fudan University. Clinical, laboratory, and imaging data were collected and analyzed to identify independent risk factors by logistic regression analyses. The predictor was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curves.

Results

In total, 48 patients were identified, and 31 cases (64.5%) had a permanent shunt. EVD was effective in accelerating cerebrospinal fluid purification. In the permanent shunt group, the duration of EVD was significantly longer (28.5 ± 5.2 vs 14.9 ± 3.0 P < 0.05) and the frontal and occipital horn ratio (FOHR) at 7–10 days after EVD was significantly higher (0.57 ± 0.01 vs 0.48 ± 0.01 P < 0.001). The FOHR at 7–10 days after EVD predicts the need for a permanent shunt with an area under the ROC curve of 0.818.

Conclusion

EVD was effective for purification of CSF, whereas a permanent shunt was needed for more than half of the patients. The FOHR at 7–10 days after EVD may be a strong predictor for a permanent shunt.

中文翻译：

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儿科感染性脑积水治疗后室壁引流后永久性分流的预测因素—一项回顾性队列研究

目的

评估外部脑室引流（EVD）的治疗效果并预测感染后脑积水（PIHC）婴儿需要永久性分流的必要性。

方法

这是一项复旦大学附属儿童医院于2013年1月至2017年12月期间诊断为PIHC并经EVD治疗的婴儿的回顾性研究。收集和分析临床，实验室和影像学数据，以通过逻辑回归分析确定独立的危险因素。使用接收器工作特性（ROC）曲线的曲线下面积（AUC）评估预测变量。

结果

总共鉴定出48例患者，其中31例（64.5％）有永久性分流。EVD可以有效地加速脑脊液的净化。在永久性分流组中，EVD的持续时间明显更长（28.5±5.2对14.9±3.0 P <0.05），并且在EVD后7-10天的额叶和枕角比例（FOHR）显着更高（0.57±0.01 vs 0.48±0.01 P <0.001）。EVD后7-10天的FOHR预测需要永久性分流，且ROC曲线下的面积为0.818。

结论

EVD可有效纯化CSF，而一半以上的患者需要永久性分流。EVD后7-10天的FOHR可能是永久分流的有力预测指标。