The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest

Choi, Seung Pill; Park, H K; Park, K N; Kim, Y M; Ahn, Kook Jin; Choi, Kyu-Sun; Lee, W J; Jeong, Sikyoung

doi:10.1136/emj.2007.053306

Cited by 115 publications

(89 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most CT-based studies on the GWR have addressed its utility as a reliable predictor of poor neuro- A SOFA score >11 has predictive power for high mortality. 13 A GCS score <8 is predictive of poor outcomes. OR, odds ratio.…”

Section: Discussionmentioning

confidence: 99%

Useful Computed Tomography Score for Estimation of Early Neurologic Outcome in Post-Cardiac Arrest Patients With Therapeutic Hypothermia

Lee

Choi

et al. 2017

Circ J

View full text Add to dashboard Cite

Background:The Alberta Stroke Program Early CT Score (ASPECTS) is used to assess early ischemic stroke damage. This study compared bilateral ASPECTS (ASPECTS-b) with the gray:white matter ratio (GWR) and quantitative regional abnormality (QRA) to evaluate the prognostic utility of early computed tomography (CT) findings in post-cardiac arrest patients. Methods and Results:Out-of-hospital cardiac arrest patients with return of spontaneous circulation (ROSC) who underwent brain CT (<6 h after onset) and therapeutic hypothermia were recruited from a university hospital over a 2-year period. General demographics, ROSC characteristics, ASPECTS-b (total score=20 points), GWR, and QRA were assessed. Multivariate logistic regression analysis was used to predict neurologic outcome using cerebral performance category (CPC) at 1 month. The study population was divided into good (n=20; CPC 1-2) and poor (n=47; CPC 3-5) outcome groups. The good (vs. poor) outcome group was younger (mean [±SD] age 46.7±11.8 vs. 60.3±17.2 years; P=0.002) and had more initial shockable rhythms (40.0% vs. 8.5%; P=0.002). In addition, the good outcome group had a higher mean ASPECTS-b score (15.3±2.7 vs. 9.0±4.9; P<0.001), despite no differences in QRA and mean GWR. Age and ASPECTS-b were independent predictors of outcome after adjusting for potential confounders. Conclusions:These findings suggest that an initial CT score (ASPECTS-b) could help estimate early neurologic outcomes in postcardiac arrest patients treated with therapeutic hypothermia.

show abstract

Section: Discussionmentioning

confidence: 99%

Useful Computed Tomography Score for Estimation of Early Neurologic Outcome in Post-Cardiac Arrest Patients With Therapeutic Hypothermia

Lee

Choi

et al. 2017

Circ J

View full text Add to dashboard Cite

show abstract

“…For the critical outcome of survival with unfavorable neurologic status or death at discharge, we identified 3 studies on CT (113 patients; very-low-quality evidence) 294,333,334 and 2 studies on MRI (40 patients; verylow-quality evidence). 316,335 For the critical outcome of survival with unfavorable neurologic status or death at 90 days, we identified 2 studies on MRI (61 patients; low-or very-low-quality evidence).…”

Section: Imagingmentioning

confidence: 99%

“…In 2 studies 333,334 (total 60 patients; very-low-quality evidence), a GWR between the caudate nucleus and the posterior limb of internal capsule (CN/PIC) below 1.22 within 24 hours or below 1.18 within 48 hours from ROSC predicted poor outcome, with 0 (0-28)% and 17 (0-64)% FPR, respectively. At 72 hours from ROSC, the presence of diffuse brain swelling on CT predicts a poor outcome, with 0 (0-45)% FPR and 52 (37-67)% sensitivity 294 (1 study, 53 patients; very-low-quality evidence).…”

Section: S126 Circulationmentioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

552

125

View full text Add to dashboard Cite

Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

show abstract

“…Nevertheless, non-specific signs of poor prognosis, such as brain swelling, may also be observed. The loss of differentiation between grey and white matter on early (\24-48 h) CT-scan has been associated with poor neurological outcome [54][55][56]. This can be quantified by calculating the ratio, in Houndsfield Units (HU), of grey over white matter (GWR), which is lower in those patients with poor neurological outcome.…”

Section: Brain Imaging (Ct-scan and Mri)mentioning

confidence: 99%

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Taccone¹,

Colpaert²,

Waele³

et al. 2015

Resuscitation

View full text Add to dashboard Cite

The prognosis of patients who are admitted to the hospital after cardiac arrest often relies on neurological examination, which could be significantly influenced by the use of sedative drugs or the implementation of targeted temperature management. The need for early and accurate prognostication is crucial as up to 15-20% of patients could be considered as having a poor outcome and may undergo withdrawal of life-sustaining therapies while a complete neurological recovery is still possible. As current practice in Belgium is still based on a very early assessment of neurological function in these patients, the Belgian Society of Intensive Care Medicine created a multidisciplinary Task Force to provide an optimal approach for monitoring and refine prognosis of CA survivors. This Task Force underlined the importance to use a multimodal approach using several additional tools (e.g., electrophysiological tests, neuroimaging, biomarkers) and to refer cases with uncertain prognosis to specialized centers to better evaluate the extent of brain injury in these patients.

show abstract

The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest

Abstract: The GM/WM ratio correlates with the outcome of hypoxic ischaemic encephalopathy and may be useful as an objective early predictor of vegetative state or death in comatose patients after cardiac arrest.

Cited by 115 publications

References 17 publications

Useful Computed Tomography Score for Estimation of Early Neurologic Outcome in Post-Cardiac Arrest Patients With Therapeutic Hypothermia

Useful Computed Tomography Score for Estimation of Early Neurologic Outcome in Post-Cardiac Arrest Patients With Therapeutic Hypothermia

Part 4: Advanced Life Support

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Contact Info

Product

Resources

About