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. 2021 Nov 22;21(1):456.
doi: 10.1186/s12883-021-02480-6.

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

Konrad Kirsch  1 , Stefan Heymel  2 , Albrecht Günther  3 , Kathleen Vahl  4 , Thorsten Schmidt  5 , Dominik Michalski  6 , Michael Fritzenwanger  2 , Paul Christian Schulze  7 , Rüdiger Pfeifer  2
Affiliations

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

Konrad Kirsch et al. BMC Neurol. .

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.

Keywords: Cardiopulmonary resuscitation; Coma; Heart arrest; Hypoxia-ischemia, brain; Neuroimaging; Predictive value of tests; Prognosis; Retrospective studies.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Change in attenuation with respect to CT timing
Fig. 2
Fig. 2
Dependency of GWR on CT timing
See this image and copyright information in PMC

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References

    1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation. 2018;137:CIR.00000000000. doi: 10.1161/CIR.0000000000000558. - DOI - PubMed
    1. Grasner JT, Wnent J, Herlitz J, et al. Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa TWO study. Resuscitation. 2020;148:218–226. doi: 10.1016/j.resuscitation.2019.12.042. - DOI - PubMed
    1. Dragancea I, Rundgren M, Englund E, Friberg H, Cronberg T. The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest. Resuscitation. 2013;84:337–342. doi: 10.1016/j.resuscitation.2012.09.015. - DOI - PubMed
    1. Beesems SG, Wittebrood KM, de Haan RJ, Koster RW. Cognitive function and quality of life after successful resuscitation from cardiac arrest. Resuscitation. 2014;85:1269–1274. doi: 10.1016/j.resuscitation.2014.05.027. - DOI - PubMed
    1. Cronberg T, Lilja G, Horn J, et al. Neurologic function and health-related quality of life in patients following targeted temperature management at 33 degrees C vs 36 degrees C after out-of-hospital cardiac arrest: a randomized clinical trial. JAMA Neurol. 2015;72:634–641. doi: 10.1001/jamaneurol.2015.0169. - DOI - PubMed