Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest

Abstract 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 resu...

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Autores principales:	Konrad Kirsch, Stefan Heymel, Albrecht Günther, Kathleen Vahl, Thorsten Schmidt, Dominik Michalski, Michael Fritzenwanger, Paul Christian Schulze, Rüdiger Pfeifer
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Heart arrest Cardiopulmonary resuscitation Hypoxia-ischemia, brain Neuroimaging Coma Prognosis Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/5a62108f14ab4b13af3cf9ba4136e710
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spelling	oai:doaj.org-article:5a62108f14ab4b13af3cf9ba4136e7102021-11-28T12:11:29ZPrognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest10.1186/s12883-021-02480-61471-2377https://doaj.org/article/5a62108f14ab4b13af3cf9ba4136e7102021-11-01T00:00:00Zhttps://doi.org/10.1186/s12883-021-02480-6https://doaj.org/toc/1471-2377Abstract 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.Konrad KirschStefan HeymelAlbrecht GüntherKathleen VahlThorsten SchmidtDominik MichalskiMichael FritzenwangerPaul Christian SchulzeRüdiger PfeiferBMCarticleHeart arrestCardiopulmonary resuscitationHypoxia-ischemia, brainNeuroimagingComaPrognosisNeurology. Diseases of the nervous systemRC346-429ENBMC Neurology, Vol 21, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Heart arrest Cardiopulmonary resuscitation Hypoxia-ischemia, brain Neuroimaging Coma Prognosis Neurology. Diseases of the nervous system RC346-429
spellingShingle	Heart arrest Cardiopulmonary resuscitation Hypoxia-ischemia, brain Neuroimaging Coma Prognosis Neurology. Diseases of the nervous system RC346-429 Konrad Kirsch Stefan Heymel Albrecht Günther Kathleen Vahl Thorsten Schmidt Dominik Michalski Michael Fritzenwanger Paul Christian Schulze Rüdiger Pfeifer Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest
description	Abstract 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.
format	article
author	Konrad Kirsch Stefan Heymel Albrecht Günther Kathleen Vahl Thorsten Schmidt Dominik Michalski Michael Fritzenwanger Paul Christian Schulze Rüdiger Pfeifer
author_facet	Konrad Kirsch Stefan Heymel Albrecht Günther Kathleen Vahl Thorsten Schmidt Dominik Michalski Michael Fritzenwanger Paul Christian Schulze Rüdiger Pfeifer
author_sort	Konrad Kirsch
title	Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest
title_short	Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest
title_full	Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest
title_fullStr	Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest
title_full_unstemmed	Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest
title_sort	prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest
publisher	BMC
publishDate	2021
url	https://doaj.org/article/5a62108f14ab4b13af3cf9ba4136e710
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Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest

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