Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care.
Sunghyuk LeeJung-Soo ParkYeonho YouJin Hong MinWon Joon JeongHong Joon AhnYong Nam InYong Chul ChoIn Ho LeeJae Kwang LeeChangshin KangPublished in: Diagnostics (Basel, Switzerland) (2023)
We investigated prognostic strategies for predicting good outcomes in the early stage of post-cardiac-arrest care using multiple prognostic tests that are available until 24 h after the return of spontaneous circulation (ROSC). A retrospective analysis was conducted on 138 out-of-hospital cardiac-arrest patients who underwent prognostic tests, including the gray-white-matter ratio (GWR-BG), the Glasgow Coma Scale motor (GCS-M) score before sedative administration, and the neuron-specific enolase (NSE) level measured at 24 h after the ROSC. We investigated the prognostic performances of the tests as single predictors and in various combination strategies. Classification and regression-tree analysis were used to provide a reliable model for the risk stratification. Out of all the patients, 55 (44.0%) had good outcomes. The NSE level showed the highest prognostic performance as a single prognostic test and provided improved specificities (>70%) and sensitivities (>98%) when used in combination strategies. Low NSE levels (≤32.1 ng/mL) and high GCS-M (≥4) scores identified good outcomes without misclassification. The overall accuracy for good outcomes was 81.8%. In comatose patients with low NSE levels or high GCS-M scores, the premature withdrawal of life-sustaining therapy should be avoided, thereby complying with the formal prognostication-strategy algorithm after at least 72 h from the ROSC.
Keyphrases
- cardiac arrest
- early stage
- end stage renal disease
- healthcare
- newly diagnosed
- chronic kidney disease
- ejection fraction
- cardiopulmonary resuscitation
- white matter
- palliative care
- machine learning
- deep learning
- type diabetes
- prognostic factors
- stem cells
- squamous cell carcinoma
- peritoneal dialysis
- mesenchymal stem cells
- adipose tissue
- metabolic syndrome
- high resolution
- multiple sclerosis
- radiation therapy
- glycemic control
- health insurance
- brain injury
- insulin resistance
- subarachnoid hemorrhage
- rectal cancer
- data analysis
- replacement therapy