Establishment Of A Model For Predicting The Postoperative Effect Of Shunt Surgery For Chronic Disorders Of Consciousness With Normal Pressure Hydrocephalus

Background:To investigate the imaging of patients with prolonged disorders ofconsciousness with normal pressure hydrocephalus and predictive role of indicators of quantitative electroencephalogram after cerebrospinal fluid tap test in the postoperative outcome of patients’shunt.Methods:In this study,Sixty patients diagnosed with normal pressure hydrocephalus with different levels of consciousness disorder treated at the First Affiliated Hospital of Nanchang University from September 2020 to December 2022.All enrolled cases were recorded with the magnetic resonance scan on admission.Quantitative EEG monitoring was performed after fluid release test.symptomatology before and after fluid release test was recorded and evaluated by CRS-R and GCS-P scales.Postoperative follow-up was conducted at the third month,and patients’prognosis was judged according to the Coma Recovery Scale score,effective group(≥2-point increase in CRS-R score)and ineffective group(≤1-point increase in CRS-R score).Multivariate Logistic regression was used to screen the predictors and construct the column line graphs After building the model,the receiver operating characteristic(ROC)curve,the area under the curve(AUC)and Hosmer-Lemeshow test were used to evaluate the model.Result:A total of sixty patients were included in the analysis,including 36 in the model group and 24 in the validation group;44(73.3%)in the surgically effective group and16(53.8%)in the surgically ineffective group.Multivariate Logistic regression analysis showed that CA(OR=0.973,95%CI:0.965-0.982),a EEG(OR=1.890,95%CI:1.719-2.079),lumbar puncture test(OR=1.092,95%CI:1.029-1.159)and preoperative CRS-R score(OR=1.022,95%CI:1.009-1.035)were independent risk factors affecting prognosis.The AUCs for clinical prognosis in the model and validation groups were 0.801(95%CI:0.651～0.951)and 0.743(95%CI:0.593～0.992),respectively.After he risk stratification based on the line graph model,the surgical effective rate was significantly higher in low risk patients than that of medium and high risk patients in the model group and validation group.Hosmer-Lemeshow test showed that there was a good fitting degree for the line graph model(χ~2=0.449 in the model group,χ~2=6.936 in the validation group,both P>0.05).Conclusions:The column line graph model constructed in this study can better predict the prognostic efficacy of shunt in patients with prolonged disorders of consciousness with normal pressure hydrocephalus,and more comprehensively assess the preoperative hydrocephalus and consciousness of patients,which can guide the clinical treatment and prognostic prediction.