Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Post-Cardiac-Arrest Care
2.3. Data Acquisition
2.3.1. Baseline Characteristics
2.3.2. Gray-White Matter Ratio
2.3.3. Clinical Examination
2.3.4. Serum Biomarkers
2.4. Outcome
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics of Total Cohort
3.2. Associations between Prognostic Tests and Neurological Outcomes
3.3. Prognostic Performances of Single Prognostic Tests and Combination Strategies
3.4. CART Analysis for Good Neurological Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Total Patients n = 125 | Good Neurological Outcome n = 55 | Poor Neurological Outcome n = 70 | p |
---|---|---|---|---|
Age, years | 58 (42–70) | 59 (45–70) | 58 (40–69) | 0.97 |
Sex, male | 93 (74.4) | 45 (81.8) | 48 (68.6) | 0.11 |
Charlson comorbidity index | 2.0 (1.0–4.0) | 2.5 (1.0–4.0) | 2.0 (0.0–4.0) | 0.61 |
Hypertension | 42 (33.6) | 18 (32.7) | 24 (34.3) | 0.86 |
Diabetes mellitus | 37 (29.6) | 15 (27.3) | 22 (31.5) | 0.82 |
Myocardial infarction | 13 (10.4) | 8 (14.5) | 5 (7.1) | 0.18 |
Cerebrovascular attack | 4 (3.2) | 2 (3.6) | 2 (2.9) | 0.81 |
Lung disease | 7 (5.6) | 1 (1.8) | 6 (8.6) | 0.10 |
Renal disease | 19 (15.2) | 8 (14.5) | 11 (15.8) | 0.92 |
Liver disease | 4 (3.2) | 2 (3.6) | 2 (2.8) | 0.49 |
Malignancy | 7 (5.6) | 4 (7.3) | 3 (4.3) | 0.50 |
Cardiac arrest characteristics | ||||
Witnessed | 75 (60.0) | 48 (87.3) | 27 (38.6) | <0.001 |
Bystander CPR | 86 (68.8) | 45 (81.8) | 41 (58.6) | 0.005 |
Shockable rhythm | 40 (32.0) | 33 (60.0) | 7 (10.0) | <0.001 |
Cardiac etiology | 54 (43.2) | 39 (70.9) | 15 (21.4) | <0.001 |
No-flow time, min | 1.0 (0.0–13.0) | 1.0 (0.0–2.0) | 9.0 (0.0–23.0) | <0.001 |
Low-flow time, min | 20.0 (10.3–30.8) | 13.0 (8.0–19.0) | 28.0 (19.8–37.3) | <0.001 |
SOFA score | 10 (8–12) | 8 (7–11) | 11 (9–12) | 0.62 |
Time (from the ROSC), hours | ||||
to targeted temperature | 5.8 (4.6–7.3) | 5.6 (4.5–7.0) | 5.9(4.6–7.5) | 0.88 |
to perform brain CT | 1.4 (0.9–2.6) | 1.1 (0.8–2.1) | 1.7 (0.9–2.9) | 0.22 |
to measure GCS-M score | 2.5 (1.5–4.2) | 2.3 (1.1–3.2) | 3.6 (2.2–6.0) | 0.003 |
CAG performed | 43 (34.4) | 35 (63.6) | 8 (11.4) | <0.001 |
Abnormal finding | <0.001 | |||
LM | 2 (4.7) | 2 (5.7) | 0 (0) | |
LAD | 13 (30.2) | 10 (28.6) | 3 (37.5) | |
LCx | 9 (20.9) | 7 (20.0) | 2 (25.0) | |
RCA | 10 (23.3) | 9 (25.7) | 1 (12.5) |
Prognostic Tests | Total Patients | Good Neurological Outcome n = 55 | Poor Neurological Outcome n = 77 | p |
---|---|---|---|---|
GWR-BG | 1.20 (1.13–1.28) | 1.25 (1.20–1.30) | 1.16 (1.05–1.22) | <0.001 |
GCS-M score | 1 (1–4) | 4 (1–4) | 1 (1–1) | <0.001 |
NSE level, ng/mL | 35.8 (22.9–110.0) | 24.3 (18.7–31.0) | 83.9 (37.7–251.3) | <0.001 |
Values | Cut-off | Specificity (95% CI) | Sensitivity (95% CI) | PPV (95% CI) | NPV (95% CI) | TP | FP | TN | FN |
---|---|---|---|---|---|---|---|---|---|
GWR-BG | >1.2 | 70.0 (57.9–80.4) | 72.7 (59.0–83.1) | 65.6 (52.3–77.3) | 76.6 (64.3–86.2) | 40 | 21 | 49 | 15 |
>1.11 | 41.4 (29.8–53.8) | 98.2 (90.3–100.0) | 56.8 (46.3–67.0) | 96.7 (82.8–99.9) | 54 | 41 | 29 | 1 | |
>1.09 | 38.6 (27.2–51.0) | 100.0 (93.5–100.0) | 56.1 (45.7–66.1) | 100 (87.2–100.0) | 55 | 43 | 27 | 0 | |
GCS-M score | >2 | 88.6 (78.7–94.9) | 65.6 (51.4–77.8) | 81.8 (67.3–91.8) | 76.5 (65.8–85.2) | 36 | 8 | 62 | 19 |
NSE level, ng/mL | ≤32 | 82.9 (72.0–90.8) | 81.8 (69.1–90.9) | 78.9 (66.1–88.6) | 85.3 (74.6–92.7) | 45 | 12 | 58 | 10 |
≤58.9 | 58.6 (46.2–70.2) | 98.2 (90.3–100.0) | 65.1 (53.8–75.2) | 97.6 (87.4–99.9) | 54 | 29 | 41 | 1 | |
≤85.3 | 51.4 (39.2–63.6) | 100.0 (93.5–100.0) | 61.8 (50.9–71.9) | 100.0 (90.3–100.0) | 55 | 34 | 36 | 0 |
Values | AUC (95% CI) | p-Value a | Specificity (95% CI) | Sensitivity (95% CI) | PPV (95% CI) | NPV (95% CI) | ||
---|---|---|---|---|---|---|---|---|
GWR-BG + GCS-M score | 0.89 (0.82–0.94) | * | 37.1 (25.9–49.5) | 98.2 (90.3–100.0) | 55.1 (44.7–65.2) | 96.3 (81.0–99.9) | ||
GWR-BG + NSE level | 0.90 (0.83–0.94) | 0.85 | * | 71.4 (59.4–81.6) | 98.2 (90.3–100.0) | 73.0 (61.4–82.6) | 98.0 (89.6–100.0) | |
GCS-M score + NSE level | 0.93 (0.87–0.97) | 0.15 | 0.20 | * | 72.9 (60.9–82.8) | 98.2 (90.3–100.0) | 74.0 (62.4–83.5) | 98.1 (89.7–100.0) |
GWR-BG + GCS-M score + NSE level | 0.96 (0.90–0.98) | 0.002 | 0.005 | 0.09 | 77.1 (65.6–86.3) | 98.2 (90.3–100.0) | 77.1 (65.6–86.3) | 98.2 (90.3–100.0) |
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Lee, S.; Park, J.S.; You, Y.; Min, J.H.; Jeong, W.; Ahn, H.J.; In, Y.N.; Cho, Y.C.; Lee, I.H.; Lee, J.K.; et al. Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care. Diagnostics 2023, 13, 2174. https://doi.org/10.3390/diagnostics13132174
Lee S, Park JS, You Y, Min JH, Jeong W, Ahn HJ, In YN, Cho YC, Lee IH, Lee JK, et al. Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care. Diagnostics. 2023; 13(13):2174. https://doi.org/10.3390/diagnostics13132174
Chicago/Turabian StyleLee, Sunghyuk, Jung Soo Park, Yeonho You, Jin Hong Min, Wonjoon Jeong, Hong Joon Ahn, Yong Nam In, Yong Chul Cho, In Ho Lee, Jae Kwang Lee, and et al. 2023. "Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care" Diagnostics 13, no. 13: 2174. https://doi.org/10.3390/diagnostics13132174
APA StyleLee, S., Park, J. S., You, Y., Min, J. H., Jeong, W., Ahn, H. J., In, Y. N., Cho, Y. C., Lee, I. H., Lee, J. K., & Kang, C. (2023). Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care. Diagnostics, 13(13), 2174. https://doi.org/10.3390/diagnostics13132174