ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
This article is part of the Research TopicExternal Ventricular Drainage in Neurological and Neurosurgical Practice: Current Trends, Challenges, and Future DirectionsView all articles
Analysis of Risk Factors for Delayed Intracranial Hemorrhage following Ventriculoperitoneal Shunt Surgery and Construction of a Nomogram model
Provisionally accepted
- Ningbo Medical Centre Lihuili Hospital, Ningbo, China
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Objective: This study aimed to identify independent risk factors for delayed intracranial hemorrhage following ventriculoperitoneal shunt surgery in hydrocephalus patients and to construct a predictive nomogram model. Methods: A retrospective analysis was conducted on 266 patients who underwent VPS at Ningbo University Affiliated Lihuili Hospital between January 2015 and December 2024. Patients were stratified into DICH and non-DICH groups. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors (P<0.05). A nomogram was developed using R software, and its predictive performance was evaluated using ROC and calibration curves. Results: The incidence of DICH was 17.3%. The DICH group had significantly higher age, greater prevalence of prior craniotomy, and elevated NLRR (P<0.05). Multivariate analysis identified age (OR=1.061), craniotomy history (OR=2.676), and NLRR (OR=1.931) as independent risk factors (P<0.05). The nomogram showed an AUC of 0.80, sensitivity of 87.7%, specificity of 60.9%, PPV of 91.5%, NPV of 50.9%, and cutoff value of 0.254. The Hosmer-Lemeshow test (?²=10.145, P=0.255) indicated good calibration. Conclusion: Advanced age, craniotomy history, and elevated NLRR are independent risk factors for DICH post-VPS. The constructed nomogram demonstrates favorable predictive performance. Enhanced postoperative vigilance and increased CT monitoring are recommended for high-risk patients to enable early intervention.
Keywords: delayed intracranial hemorrhage, Hydrocephalus, influencing factor, nomogram, Ventriculoperitoneal Shunt
Received: 29 Oct 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 林, Hongcai and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wang Hongcai
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