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Tytuł:
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Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest.
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Autorzy:
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Kirsch K; Department of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany. .
Heymel S; Department of Internal Medicine I, Division of Medical Intensive Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Günther A; Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Vahl K; Department of Radiology, Interventional Radiology and Neuroradiology, Klinikum Altenburger Land, Am Waldessaum 10, 04600, Altenburg, Germany.
Schmidt T; Department of Diagnostic and Interventional Neuroradiology, HELIOS Klinikum Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany.
Michalski D; Department of Neurology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
Fritzenwanger M; Department of Internal Medicine I, Division of Medical Intensive Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Schulze PC; Department of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Pfeifer R; Department of Internal Medicine I, Division of Medical Intensive Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Źródło:
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BMC neurology [BMC Neurol] 2021 Nov 22; Vol. 21 (1), pp. 456. Date of Electronic Publication: 2021 Nov 22.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: London : BioMed Central, [2001-
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MeSH Terms:
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Heart Arrest*/complications
Heart Arrest*/diagnostic imaging
Heart Arrest*/therapy
White Matter*/diagnostic imaging
Adult ; Coma/diagnostic imaging ; Coma/etiology ; Humans ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed
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References:
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Contributed Indexing:
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Keywords: Cardiopulmonary resuscitation; Coma; Heart arrest; Hypoxia-ischemia, brain; Neuroimaging; Predictive value of tests; Prognosis; Retrospective studies
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Entry Date(s):
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Date Created: 20211123 Date Completed: 20211124 Latest Revision: 20211126
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Update Code:
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20240105
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PubMed Central ID:
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PMC8607613
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DOI:
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10.1186/s12883-021-02480-6
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PMID:
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34809608
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Background: This study aimed to assess the prognostic value regarding neurologic outcome of CT neuroimaging based Gray-White-Matter-Ratio measurement in patients after resuscitation from cardiac arrest.
Methods: We retrospectively evaluated CT neuroimaging studies of 91 comatose patients resuscitated from cardiac arrest and 46 non-comatose controls. We tested the diagnostic performance of Gray-White-Matter-Ratio compared with established morphologic signs of hypoxic-ischaemic brain injury, e. g. loss of distinction between gray and white matter, and laboratory parameters, i. e. neuron-specific enolase, for the prediction of poor neurologic outcomes after resuscitated cardiac arrest. Primary endpoint was neurologic function assessed with cerebral performance category score 30 days after the index event.
Results: Gray-White-Matter-Ratio showed encouraging interobserver variability (ICC 0.670 [95% CI: 0.592-0.741] compared to assessment of established morphologic signs of hypoxic-ischaemic brain injury (Fleiss kappa 0.389 [95% CI: 0.320-0.457]) in CT neuroimaging studies. It correlated with cerebral performance category score with lower Gray-White-Matter-Ratios associated with unfavourable neurologic outcomes. A cut-off of 1.17 derived from the control population predicted unfavourable neurologic outcomes in adult survivors of cardiac arrest with 100% specificity, 50.3% sensitivity, 100% positive predictive value, and 39.3% negative predictive value. Gray-White-Matter-Ratio prognostic power depended on the time interval between circulatory arrest and CT imaging, with increasing sensitivity the later the image acquisition was executed.
Conclusions: A reduced Gray-White-Matter-Ratio is a highly specific prognostic marker of poor neurologic outcomes early after resuscitation from cardiac arrest. Sensitivity seems to be dependent on the time interval between circulatory arrest and image acquisition, with limited value within the first 12 h.
(© 2021. The Author(s).)
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