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. 2025 May 19;48(1):424.
doi: 10.1007/s10143-025-03588-w.

Serum uric acid is associated with shunt dependent hydrocephalus of aneurysmal subarachnoid hemorrhage patients

Ruoran Wang #  1 , Jing Zhang  1 , Jianguo Xu  2 , Min He  3
Affiliations

Serum uric acid is associated with shunt dependent hydrocephalus of aneurysmal subarachnoid hemorrhage patients

Ruoran Wang et al. Neurosurg Rev. .

Abstract

A part of aneurysmal subarachnoid hemorrhage (aSAH) patients with the hydrocephalus require permanent cerebral spinal fluid diversion and have poor prognosis. Evaluating the risk of shunt dependent hydrocephalus is important for clinicains to make personalized treatments strategies. This study was performed to explore the relationship between initial serum uric acid (SUA) level and the shunt dependent hydrocephalus of aSAH patients. The primary outcome of the study was the shunt dependent hydrocephalus. Laboratory examinations including SUA were extracted by analyzing the first blood sample after admission. Risk factors for shunt dependent hydrocephalus of aSAH was explored by univariate and multivariate logistic regression. The relationship between SUA and risk of shunt dependent hydrocephalus was shown using the restricted cubic spline (RCS) method. The logistic regression based predictive model for shunt dependent hydrocephalus of aSAH was developed by incorporating independent risk factors discovered in the multivariate logistic regression. The receiver operating characteristic curve (ROC) was drawn to evaluate the predictive accuracy of SUA and the developed model for shunt dependent hydrocephalus of aSAH. 715 aSAH patients were enrolled with the hydrocephalus incidence of 7.7%. Compared with non-hydrocephalus group, hydrocephalus group had older age (p = 0.006), higher rate of alcoholism (p = 0.017), higher WFNS (p < 0.001) and Hunt Hess (p < 0.001), higher level of SUA (p < 0.001). Moreover, aSAH patients with the hydrocephalus had higher incidence of delayed cerebral ischemia (p = 0.001), higher mortality (p = 0.004), longer length of ICU stay (p < 0.001) and length of hospital stay (p < 0.001). Five independent risk factors for the shunt dependent hydrocephalus of aSAH patients were confirmed by the multivariate logistic regression including age (p = 0.011), alcoholism (p = 0.014), WFNS (p = 0.025), white blood cell (p = 0.003), SUA (p = 0.020). The AUC of SUA for predicting the hydrocephalus was 0.643. Incorporating five factors discovered in the multivariate logistic regression, the predictive model for shunt dependent hydrocephalus had an AUC of 0.780. Increased SUA level is independently associated with the shunt dependent hydrocephalus after aSAH. The predictive model incorporating serum uric acid is useful for clinicians to evaluate the risk of shunt dependent hydrocephalus after aSAH and make suitable therapeutic schedule. Clinical trial number Not applicable.

Keywords: Aneurysmal subarachnoid hemorrhage; Hydrocephalus; Marker; Uric acid.

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Conflict of interest statement

Declarations. Ethical approval: This observational study obtained ethical approvement from the review board of West China hospital (2021 − 1684). Informed consent: Informed consent forms for being enrolled into observational studies of each patients receiving treatments in our hospital would be signed by themselves or their legal representatives once admission. Consent to participate: All authors have read and approved submission of the manuscript. Consent for publication: All of the authors gave consent for the publication of this manuscript. Competing interests: The authors declare no competing interests.

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