Timing of brain computed tomography for predicting neurological prognosis in comatose cardiac arrest survivors: a retrospective observational study

doi:10.5847/wjem.j.1920-8642.2022.080

Abstract

Abstract:

BACKGROUND: To assess the association between relevant brain computed tomography (CT) parameters at different time and neurological prognosis in adult comatose survivors after cardiac arrest (CA).

METHODS: A total of 94 CA patients who underwent early and late CT scans (within 24 h and 24 h to 7 d respectively after CA) between January 2018 and April 2020 were enrolled in this retrospective study. According to the Cerebral Performance Category (CPC) score at hospital discharge, the patients were divided into either a good outcome (CPC 1-2) group or a poor-outcome group (CPC 3-5). The grey-to-white matter ratio (GWR) and the proportion of cerebrospinal fluid volume (pCSFV) were measured. In predicting poor outcomes, the prognostic performance of relevant CT parameters was evaluated, and the comparison analysis (expressed as the ratio of parameters in late CT to those in the early CT) of different CT time was conducted.

RESULTS: Totally 26 patients were in the good-outcome group, while 68 patients were in the poor-outcome group. The putamen density, GWR, and pCSFV in late CT were significantly lower in the poor-outcome group (P<0.05). The ratios of GWR and pCSFV in the poor-outcome group were significantly decreased according to comparison analysis of different CT time (P<0.05), while there was no significant difference in the ratio of putamen density. GWR-basal ganglia <1.18 in late CT showed the best predictive value. The ratio of pCSFV <0.98 predicted unfavorable neurological outcomes with a sensitivity of 65.9% and a specificity of 93.8% (P=0.001).

CONCLUSIONS: Brain CT performed >24 h after CA may be a good choice as a neuroimaging approach to evaluating prognosis. To predict neurological prognosis, comparison analysis of different CT time can be used as another promising tool in comatose CA survivors.

Key words: Cardiac arrest, Brain computed tomography, Cerebral edema, Coma, Prognosis

Gan-nan Wang, Zhong-man Zhang, Wen Chen, Xiao-quan Xu, Jin-song Zhang. Timing of brain computed tomography for predicting neurological prognosis in comatose cardiac arrest survivors: a retrospective observational study[J]. World Journal of Emergency Medicine, 2022, 13(5): 349-354.

Figures/Tables 5

Figure 1.

Table 1.

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Figure 2.

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Parameters	Good-outcome group (n=26)	Poor-outcome group (n=68)	P-value
Age, years	52.62±16.30	49.72±19.93	0.511
Male	17 (65.4)	47 (69.1)	0.728
Comorbidities
Hypertension	12 (46.2)	27 (39.7)	0.570
Diabetes	6 (23.1)	9 (13.2)	0.395
Coronary artery disease	2 (7.7)	9 (13.2)	0.697
Stroke	3 (11.5)	7 (10.3)	0.861
Out-of-hospital CA	13 (50.0)	38 (55.9)	0.609
Bystander CPR	23 (88.5)	44 (64.7)	0.023
Cardiac etiology	15 (57.7)	31 (45.6)	0.294
Initial shockable rhythm	12 (46.2)	20 (29.4)	0.125
Duration of resuscitation, min	33.0 (19.0-45.5)	30.0 (15.5-57.5)	0.679
GCS score after ROSC	7.42±3.71	3.35±0.93	<0.001
Length of stay in hospital, d	17.5 (14.0-28.5)	9.0 (3.5-25.0)	0.010
CPC at hospital discharge
CPC 1	5	-
CPC 2	21	-
CPC 3	-	4
CPC 4	-	30
CPC 5	-	34

Parameters	Early CT (< 24 h)			Late CT (24 h to 7 d)
Parameters	Good-outcome group (n=26)	Poor-outcome group (n=68)	P-value	Good-outcome group (n=26)	Poor-outcome group (n=68)	P-value
Density of ROI, HU
PU	34.1 (33.0-36.0)	32.1 (28.2-35.9)	0.078	33.5 (28.3-35.8)	29.0 (26.0-32.0)	0.028
PLIC	27.0 (24.4-30.0)	28.0 (22.6-29.7)	0.880	25.5 (21.3-26.9)	25.0 (22.5-28.0)	0.388
GWR
Basal ganglia	1.22 (1.16-1.29)	1.17 (1.10-1.23)	0.032	1.28 (1.23-1.35)	1.12 (1.08-1.18)	<0.001
Simplified	1.24 (1.21-1.35)	1.18 (1.12-1.27)	0.052	1.33 (1.25-1.40)	1.14 (1.08-1.22)	<0.001
pCSFV	0.040 (0.034-0.077)	0.048 (0.030-0.070)	0.824	0.074 (0.047-0.107)	0.038 (0.019-0.075)	0.010

Prognostic factors	Cut-off value	Sensitivity (%)	Specificity (%)	AUC (95% CI)	P-value
GWR-basal ganglia (early CT)	1.18	61.0	68.8	0.684 (0.542-0.826)	0.032
GWR-basal ganglia (early CT)	1.12	31.7	100.0	0.684 (0.542-0.826)	0.032
GWR-basal ganglia (late CT)	1.18	87.8	93.8	0.942 (0.884-0.998)	<0.001
GWR-basal ganglia (late CT)	1.16	75.6	100.0	0.942 (0.884-0.998)	<0.001
GWR ratio	1.01	78.0	75.0	0.761 (0.614-0.907)	0.002
pCSFV (late CT)	0.03	41.5	100.0	0.721 (0.591-0.851)	0.010
pCSFV ratio	0.98	65.9	93.8	0.788 (0.671-0.906)	0.001

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