External validation of cardiac arrest-specific prognostication scores developed for early prognosis estimation after out-of-hospital cardiac arrest in a Korean multicenter cohort

Heo, Wan Young; Jung, Yong Hun; Lee, Hyoung Youn; Jeung, Kyung Woon; Lee, Byung Kook; Youn, Chun Song; Choi, Seung Pill; Park, Kyu Nam; Min, Yong‐Ki

doi:10.1371/journal.pone.0265275

Cited by 13 publications

(16 citation statements)

References 33 publications

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“…To our knowledge, this study is the third external validation of the PROLOGUE score overall and the second one performed in Europe [ 30 , 31 ]. Our findings are in line with the other European validation study performed in Austria, in which the score showed an AUROC of 0.82 (95% CI 0.80 to 0.85) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two of the most promising and thoroughly validated scoring models for the prognostication of neurological outcome after cardiac arrest are the Out-of-Hospital Cardiac Arrest (OHCA) and the Cardiac Arrest Hospital Prognosis (CAHP) scores [ 9 , 11 – 13 ]. Both of these scores have shown good prognostic accuracy in numerous previous validations [ 13 – 30 ]. A drawback of both models is the fact that they require no-flow time, which is often inaccurate or unknown, especially if the cardiac arrest was unwitnessed.…”

Section: Introductionmentioning

confidence: 99%

“…Box 1 gives an overview of the parameters included in the OHCA-, CAHP-, and PROLOGUE score. In the internal validation and one external validation, both conducted in South Korea, the PROLOGUE score showed excellent prognostic performance with areas under the receiver operating characteristic curve (AUROC) of 0.94 and 0.92 respectively [ 14 , 30 ]. Furthermore, the probability of poor neurological outcome can easily be calculated at the bedside using a nomogram provided in the original publication.…”

Section: Introductionmentioning

confidence: 99%

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External validation of the PROLOGUE score to predict neurological outcome in adult patients after cardiac arrest: a prospective cohort study

Blatter

Gökduman

Becker

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background The PROLOGUE score (PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages) is a novel prognostic model for the prediction of neurological outcome after cardiac arrest, which showed exceptional performance in the internal validation. The aim of this study is to validate the PROLOGUE score in an independent cohort of unselected adult cardiac arrest patients and to compare it to the thoroughly validated Out-of-Hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP) scores. Methods This study included consecutive adult cardiac arrest patients admitted to the intensive care unit (ICU) of a Swiss tertiary teaching hospital between October 2012 and July 2022. The primary endpoint was poor neurological outcome at hospital discharge, defined as a Cerebral Performance Category (CPC) score of 3 to 5 including death. Results Of 687 patients included in the analysis, 321 (46.7%) survived to hospital discharge with good neurological outcome, 68 (9.9%) survived with poor neurological outcome and 298 (43.4%) died. The PROLOGUE score showed an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI 0.80 to 0.86) and good calibration for the prediction of the primary outcome. The OHCA and CAHP score showed similar performance (AUROC 0.83 and 0.84 respectively), the differences between the three scores were not significant (p = 0.495). In a subgroup analysis, the PROLOGUE score performed equally in out-of-hospital and in-hospital cardiac arrest patients whereas the OHCA and CAHP score performed significantly better in OHCA patients. Conclusion The PROLOGUE score showed good prognostic accuracy for the early prediction of neurological outcome in adult cardiac arrest survivors in our cohort and might support early goals-of-care discussions in the ICU. Trial registration Not applicable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External validation of the PROLOGUE score to predict neurological outcome in adult patients after cardiac arrest: a prospective cohort study

Blatter

Gökduman

Becker

et al. 2023

Scand J Trauma Resusc Emerg Med

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“…In contrast, the calibration assessment in the external validation of several previous prediction models for patients with cardiac arrest with ROSC tended to overestimate poor outcomes. [33][34][35] In other words, accurate assessment by our models would decrease premature WLST in patients who could otherwise have achieved favourable neurological outcomes.…”

Section: Discussionmentioning

confidence: 99%

External Validation of Updated Prediction Models for Neurological Outcomes at 90 Days in Patients with Out-of-Hospital Cardiac Arrest

Nishioka

Yamada

Nakao

et al. 2023

Preprint

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Background The accurate prediction of neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) with post-cardiac arrest syndrome is crucial for determining the optimal treatment or termination of resuscitation efforts. Hence, this study aimed to externally validate updated prediction models for OHCA outcomes using a large nationwide dataset. Methods Existing prediction models for adult patients with non-traumatic OHCA who achieved return of spontaneous circulation were refined using data obtained from the CRITICAL study, a multicentre registry in Osaka, Japan, between January 2013 and December 2019. The primary outcome was a dichotomised 90-day Cerebral Performance Category score. The model was updated using logistic regression with least absolute shrinkage and selection operator regularisation. External validation was performed using data from the JAAM-OHCA registry between January 2014 and December 2019. This is a nationwide multicentre registry in Japan that represents a geographically distinct population from the derivation set. The model performance was evaluated using a validation set. Results Two models (Model 1 included patient demographics, pre-hospital information, and the initial rhythm upon hospital admission; Model 2 included information obtained in the hospital immediately after the return of spontaneous circulation) were updated using the derivation set (n = 3337). In the validation set (n = 4250), Model 1 and 2 exhibited a C-statistic of 0.945 (95% confidence interval (CI): 0.935–0.955) and 0.958 (95% CI: 0.951–0.960), respectively. Both models were well-calibrated to the observed outcomes. Model 2 demonstrated higher net benefits at all risk thresholds according to the decision curve analysis. A web-based calculator was developed to estimate the probability of poor outcomes (https://pcas-prediction.shinyapps.io/90d_lasso/). Conclusions In the validation set, the updated model demonstrated excellent performance in predicting neurological outcomes at 90 days in patients with OHCA. The model, enhanced by incorporating hospital-available information as a predictor, reduced reliance on ambiguous predictors and improved prediction accuracy.

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“…31 The authors reported excellent discrimination ability (AUC ¼ 0.81) for predicting favorable outcome (CPC: 1-2) at discharge, which was similar in an independent 1,163-patient cohort (AUC ¼ 0.77). 32…”

Section: C-graph Scalementioning

confidence: 99%

Clinical Grading Scales and Neuroprognostication in Acute Brain Injury

Reyes-Esteves,

Kumar,

Kasner

et al. 2023

Semin Neurol

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Prediction of neurological clinical outcome after acute brain injury is critical because it helps guide discussions with patients and families and informs treatment plans and allocation of resources. Numerous clinical grading scales have been published that aim to support prognostication after acute brain injury. However, the development and validation of clinical scales lack a standardized approach. This in turn makes it difficult for clinicians to rely on prognostic grading scales and to integrate them into clinical practice. In this review, we discuss quality measures of score development and validation and summarize available scales to prognosticate outcomes after acute brain injury. These include scales developed for patients with coma, cardiac arrest, ischemic stroke, nontraumatic intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury; for each scale, we discuss available validation studies.

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External validation of cardiac arrest-specific prognostication scores developed for early prognosis estimation after out-of-hospital cardiac arrest in a Korean multicenter cohort

Cited by 13 publications

References 33 publications

External validation of the PROLOGUE score to predict neurological outcome in adult patients after cardiac arrest: a prospective cohort study

External validation of the PROLOGUE score to predict neurological outcome in adult patients after cardiac arrest: a prospective cohort study

External Validation of Updated Prediction Models for Neurological Outcomes at 90 Days in Patients with Out-of-Hospital Cardiac Arrest

Clinical Grading Scales and Neuroprognostication in Acute Brain Injury

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