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- Title
Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care.
- Authors
Lee, Sunghyuk; Park, Jung Soo; You, Yeonho; Min, Jin Hong; Jeong, Wonjoon; Ahn, Hong Joon; In, Yong Nam; Cho, Yong Chul; Lee, In Ho; Lee, Jae Kwang; Kang, Changshin
- Abstract
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.
- Subjects
RETURN of spontaneous circulation; ADVANCED cardiac life support; PROGNOSTIC tests; GLASGOW Coma Scale; ENOLASE
- Publication
Diagnostics (2075-4418), 2023, Vol 13, Issue 13, p2174
- ISSN
2075-4418
- Publication type
Article
- DOI
10.3390/diagnostics13132174