Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Development and temporal validation of an odds ratio-weighted prognostic score (NPH-RKP) for idiopathic normal pressure hydrocephalus shunt surgery: a retrospective cohort study.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Rakip Usame, Yildizhan Serhat, Canbek İhsan, Boyacı Mehmet Gazi, Korkmaz Serhat, Kimsesiz Omer, Guzel Abdullah, Abdallah Anas, Aslan Adem
Аннотация
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a major cause of reversible gait and cognitive impairment in older adults, yet postoperative outcomes remain difficult to predict. Existing prognostic tools are limited by methodological shortcomings, including lack of temporal validation, dependence on subjective radiological markers, insufficient events-per-variable ratios, and absence of transparent graded risk stratification. To address these gaps, we developed the first temporally validated, odds ratio-weighted prognostic scoring system specifically designed for iNPH surgical outcomes.
METHODS: This single-center retrospective study included 114 consecutive patients treated with ventriculoperitoneal shunting between 2015 and 2024. Candidate predictors were systematically assessed, and the Normal Pressure Hydrocephalus Risk-Prediction Score (NPH-RKP) was constructed using five objective clinical variables routinely available in standard practice: age, iNPH Grading Scale score, Mini-Mental State Examination (MMSE), Fazekas score, and diagnostic delay. Four competing scoring frameworks were compared, and the odds ratio-weighted graded model was selected based on performance and interpretability. The dataset was temporally divided into development (2015-2020, n = 59) and validation (2021-2024, n = 55) cohorts. The primary endpoint was global clinical improvement at 12 months, incorporating gait, cognitive, and urinary metrics.
RESULTS: Multivariable modeling identified five independent predictors (OR range: 2.00-4.14, 95% CI: 1.82-9.42). The resulting 0-12-point NPH-RKP score demonstrated excellent discrimination in the development cohort (AUC = 0.939, 95% CI: 0.881-0.985) with strong calibration (Hosmer-Lemeshow p = 0.511; Brier score = 0.113). Temporal validation revealed retained prognostic accuracy (AUC = 0.824, 95% CI: 0.715-0.933), with expected performance attenuation attributable to evolving clinical practice and improved surgical outcomes. Distinct risk strata yielded sharply separated success rates: low-risk (0-4 points, 91.4%), intermediate-risk (5-7 points, 62.5%), and high-risk (8-12 points, 8.3%). The model achieved a robust EPV of 7.8, outperforming prior iNPH tools while maintaining ease of calculation.
CONCLUSIONS: The NPH-RKP provides a transparent, clinically accessible, and methodologically rigorous prognostic framework for predicting iNPH shunt outcomes. Its objective parameters, grading structure, and temporal validation enhance its clinical applicability in routine decision-making and patient counseling. Prospective multicenter validation is warranted to confirm its generalizability across diverse healthcare settings.
METHODS: This single-center retrospective study included 114 consecutive patients treated with ventriculoperitoneal shunting between 2015 and 2024. Candidate predictors were systematically assessed, and the Normal Pressure Hydrocephalus Risk-Prediction Score (NPH-RKP) was constructed using five objective clinical variables routinely available in standard practice: age, iNPH Grading Scale score, Mini-Mental State Examination (MMSE), Fazekas score, and diagnostic delay. Four competing scoring frameworks were compared, and the odds ratio-weighted graded model was selected based on performance and interpretability. The dataset was temporally divided into development (2015-2020, n = 59) and validation (2021-2024, n = 55) cohorts. The primary endpoint was global clinical improvement at 12 months, incorporating gait, cognitive, and urinary metrics.
RESULTS: Multivariable modeling identified five independent predictors (OR range: 2.00-4.14, 95% CI: 1.82-9.42). The resulting 0-12-point NPH-RKP score demonstrated excellent discrimination in the development cohort (AUC = 0.939, 95% CI: 0.881-0.985) with strong calibration (Hosmer-Lemeshow p = 0.511; Brier score = 0.113). Temporal validation revealed retained prognostic accuracy (AUC = 0.824, 95% CI: 0.715-0.933), with expected performance attenuation attributable to evolving clinical practice and improved surgical outcomes. Distinct risk strata yielded sharply separated success rates: low-risk (0-4 points, 91.4%), intermediate-risk (5-7 points, 62.5%), and high-risk (8-12 points, 8.3%). The model achieved a robust EPV of 7.8, outperforming prior iNPH tools while maintaining ease of calculation.
CONCLUSIONS: The NPH-RKP provides a transparent, clinically accessible, and methodologically rigorous prognostic framework for predicting iNPH shunt outcomes. Its objective parameters, grading structure, and temporal validation enhance its clinical applicability in routine decision-making and patient counseling. Prospective multicenter validation is warranted to confirm its generalizability across diverse healthcare settings.