背景:灰白质比(GWR),通过计算机断层扫描(CT)测量,通常用于预测院外心脏骤停(OHCA)后不良的神经系统预后。GWR在接受体外心肺复苏(ECPR)的OHCA患者中的预后表现尚不清楚。
方法:本研究是对SAVE-JII注册数据的二次分析,回顾,多中心研究。根据1.00至1.39的平均GWR(aGWR)值,以0.1个间隔将参与者分为四组。计算双侧基底节的aGWR值,半谷中心,ECPR后24h内头部CT获得的高凸度。主要结果是在30天的神经学结果较差。
结果:总计,1,146例接受ECPR治疗的OHCA患者被纳入我们的分析。总的来说,aGWR较低的参与者更有可能有较差的神经系统结局,aGWR1.00-1.09(94.6%),aGWR1.10-1-19(87.8%),aGWR1.20-1.29(78.5%),和aGWR1.30-1.39(70.3%)。多变量logistic回归显示,在30天,较低的aGWR与较差的神经系统预后相关。aGWR1.30-1.39:参考,aGWR1.00-1.09:调整后优势比(AOR)10.01(95%置信区间(CI)[3.58-27.99]),aGWR1.10-1.19:aOR4.83(95%CI[2.31-10.12]),aGWR1.20-1.29:aOR2.16(95%CI[1.02-4.55])。受试者工作特征曲线分析显示,aGWR的预后表现曲线下面积为0.628,95%CI[0.59-0.66])。1.005的aGWR阈值用于预测不良的神经系统结果达到100%特异性和0.1%灵敏度。
结论:ECPR后,根据GWR进行早期神经预测可能不够,需要采用多模式方法。
BACKGROUND: Gray-to-white matter ratio (GWR), measured by computed tomography (CT), is commonly used to predict poor neurological outcomes after out-of-hospital cardiac arrest (OHCA). The prognostic performance of GWR in OHCA patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) is not known.
METHODS: This study is a secondary analysis of data from the SAVE-J II registry, a retrospective, multicenter study. Participants were divided into four groups according to average GWR (aGWR) values ranging from 1.00 to 1.39, separated by 0.1 intervals. The aGWR values were calculated for bilateral basal ganglia, centrum semiovale, and high convexity obtained by head CT within 24 h after ECPR. Primary outcome was poor neurological outcomes at 30-day.
RESULTS: In total, 1,146 OHCA patients treated with ECPR were included in our analysis. Overall, participants with lower aGWR more likely had poor neurological outcomes, aGWR 1.00-1.09 (94.6%), aGWR 1.10-1-19 (87.8%), aGWR 1.20-1.29 (78.5%), and aGWR 1.30-1.39 (70.3%). Multivariable logistic regression showed that lower aGWR was associated with poor neurological outcome at 30-day, aGWR 1.30-1.39: reference, aGWR 1.00-1.09: adjusted odds ratio (aOR) 10.01 (95% confidence interval (CI) [3.58-27.99]), aGWR 1.10-1.19: aOR 4.83 (95% CI [2.31-10.12]), aGWR 1.20-1.29: aOR 2.16 (95% CI [1.02-4.55]). Receiver operating characteristic curve analysis revealed that the prognostic performance of aGWR had an area under the curve of 0.628, 95% CI [0.59-0.66]). The aGWR threshold of 1.005 for predicting poor neurological outcome reached 100% specificity with 0.1% sensitivity.
CONCLUSIONS: Early neuro-
prognostication depending on GWR may not be sufficient after ECPR and requires a multimodal approach.