The prognostic value of gray-white-matter ratio in cardiac arrest patients treated with hypothermia

Abstract

BackgroundMild therapeutic hypothermia alters the validity of a number of parameters currently used to predict neurological outcome after cardiac arrest and resuscitation. Thus, additional parameters are needed to increase certainty of early prognosis in these patients. A promising new approach is the determination of the gray-white-matter ratio (GWR) in cranial computed tomography (CCT) obtained early after resuscitation. It is not known how GWR relates to established outcome parameters such as neuron specific enolase (NSE) or somatosensory evoked potentials (SSEP).MethodsCardiac arrest patients (n = 98) treated with hypothermia were retrospectively analyzed with respect to the prognostic value of GWR, NSE and SSEP.ResultsA GWR < 1.16 predicted poor outcome with 100% specificity and 38% sensitivity. In 62 patients NSE, SSEP and CCT were available. The sensitivity of poor outcome prediction by both NSE > 97 μg/L and bilateral absent SSEP was 43%. The sensitivity increased to 53% in a multi-parameter approach predicting poor outcome using at least two of the three parameters (GWR, NSE and SSEP).ConclusionOur results suggest a strong association of a low GWR with poor outcome following cardiac arrest. Determination of the GWR increases the sensitivity in a multi-parameter approach for prediction of poor outcome after cardiac arrest.

Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients

“…16 Cristia et al included 77 patients with an early cerebral CT performed within 24 h from OHCA. 27 They showed similar results and suggested that a low 'grey/white attenuation ratio' may be used for predicting poor outcome, 27 which was also found by Scheel et al 28 . In our study we were not able to measure the 'grey/white attenuation ratio', however we found similar results on the CT scans with 'reduced discrimination between grey and white matter' independently associated with higher mortality rates.…”

Prognostic values of gray matter to white matter ratios on early brain computed tomography in adult comatose patients after out-of-hospital cardiac arrest of cardiac etiology

“…[16][17][18] However, previous studies have included cardiac arrests of both etiologies, and did not consider etiology-based differences. [9][10][11][12][13][14][15] For example, in the study by Scheel et al, 15 the arrest etiology was cardiac only in 53% of included subjects.…”

“…Several previous studies found that gray matter to white matter ratio (GWR), calculated by dividing densities of gray matter by those of white matter, was significantly lower in cardiac arrest survivors with poor outcome relative to patients with good outcome, and thus that decreased GWR could predict poor outcome in cardiac arrest patients. [9][10][11][12][13][14] Scheel et al 15 evaluated the prognostic performance of GWR in 98 cardiac arrest survivors, and found a strong association of a low GWR with poor outcome. However, the ability of the GWR to predict outcomes in comatose patients after out-of-hospital cardiac arrest (OHCA) of cardiac etiology needs to be reassessed.…”

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

“…Moreover, a low GWR was more effective to predict the neurologic outcome in a CA with hypoxic etiology rather than a nonhypoxic etiology [57]. In patients who were treated with TTM, an averaged GWR (taken at the basal ganglia and cortical levels) of \1.16 was predictive of poor outcome [58]. CT can also be combined with other predictors to improve the predictive performance.…”