The prognostic value of gray-white-matter ratio in cardiac arrest patients treated with
hypothermia
Sammanfattning
Background
Mild therapeutic hypothermia alters the validity of a number of parameters currently used to predict
neurological outcome after cardiac arrest and resuscitation. Thus, additional parameters are needed
to increase certainty of early prognosis in these patients. A promising new approach is the
determination of the gray-white-matter ratio (GWR) in cranial computed tomography (CCT) obtained
early after resuscitation. It is not known how GWR relates to established outcome parameters such
as neuron specific enolase (NSE) or somatosensory evoked potentials (SSEP).
Methods
Cardiac arrest patients (n = 98) treated with hypothermia were retrospectively analyzed with respect
to the prognostic value of GWR, NSE and SSEP.
Results
A GWR < 1.16 predicted poor outcome with 100% specificity and 38% sensitivity. In 62 patients NSE,
SSEP and CCT were available. The sensitivity of poor outcome prediction by both NSE > 97 ?g/L and
bilateral absent SSEP was 43%. The sensitivity increased to 53% in a multi-parameter approach
predicting poor outcome using at least two of the three parameters (GWR, NSE and SSEP).
Conclusion
Our results suggest a strong association of a low GWR with poor outcome following cardiac arrest.
Determination of the GWR increases the sensitivity in a multi-parameter approach for prediction of
poor outcome after cardiac arrest.