Pediatric ventriculoperitoneal shunt failure and cerebrospinal fluid protein

Purpose Ventriculoperitoneal shunts (VPS) are a life-saving intervention for hydrocephalus. Device failure is extremely common, and carries great morbidity for patients, their families, and the healthcare system. Predicting shunt failure remains a substantial challenge. Clinically, cerebrospinal fluid protein (CSFp) is suspected to contribute to VPS obstruction, this is widely debated, and definitive evidence is lacking. We assess the value of CSFp in predicting VPS failure due to non-infective causes. Methods: A retrospective review of VPS procedures at the Queensland Children’s Hospital between 2014-2019 was conducted. The relationship between CSFp level and outcome were explored. Outcome variables were early VPS failure (< 90-days), and late VPS failure (<1-year). A CNS infection was reason for exclusion. A logarithmic correction was applied to CSFp (Log-CSFp) for statistical modelling. Results 552 procedures were assessed in 243 patients. 87 (15.8%) VP shunts failed within 90-days, 129 (23.4%) within 1-year. 77 patients (31.7%) experienced an episode of <1-year VPS failure. Multivariate analysis found Log-CSFp was predictive for early VPS failure (OR 1.19, 1.05-1.35, p=0.005), and late VPS failure (OR 1.15, 1.01-1.32, p=0.042) independent to hydrocephalus aetiology, patient age, and CSF red blood cell count. Older patient age was a significant protective factor for early (OR 0.94, 0.89-0.99, p=0.023) and late VPS failure (OR 0.89, 0.84-0.95, p<0.0001) respectively. Conclusion CSFp holds prognostic value for VPS failure in pediatric patients, a relentlessly unpredictable complication of VPS devices, informing procedure timing, patient follow-up and risk-stratification.