体外心肺复苏后 CT 评分对患者预后的价值。
Prognostic value of computed tomography score in patients after extracorporeal cardiopulmonary resuscitation.
机构信息
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
出版信息
Crit Care. 2018 Nov 22;22(1):323. doi: 10.1186/s13054-018-2101-2.
BACKGROUND
We evaluated whether Alberta Stroke Program Early Computed Tomography Score (ASPECTS) with some modifications could be used to predict neurological outcomes in patients after extracorporeal cardiopulmonary resuscitation (ECPR).
METHODS
This was a retrospective, multicenter, observational study of adult unconscious patients who were evaluated by brain computed tomography (CT) within 48 hours after ECPR between May 2010 and December 2016. ASPECTS, bilateral ASPECTS (ASPECTS-b), and modified ASPECTS (mASPECTS) were assessed by ROC curves to predict neurological outcomes. The primary outcome was neurological status upon hospital discharge assessed with the Cerebral Performance Categories (CPC) scale.
RESULTS
Among 58 unconscious patients, survival to discharge was identified in 25 (43.1%) patients. Of these 25 survivors, 19 (32.8%) had good neurological outcomes (CPC score of 1 or 2). Interrater reliability of CT scores was excellent. Intraclass correlation coefficients of ASPECTS, ASPECTS-b, and mASPECTS were 0.918 (95% CI, 0.865-0.950), 0.918 (95% CI, 0.866-0.951), and 0.915 (95% CI, 0.860-0.949), respectively. The predictive performance of mASPECTS for poor neurological outcome was better than that of ASPECTS or ASPECTS-b (C-statistic for mASPECTS vs. ASPECTS, 0.922 vs. 0.812, p = 0.004; mASPECTS vs. ASPECTS-b, 0.922 vs. 0.818, p = 0.003). A cutoff of 25 for poor neurological outcome had a sensitivity of 84.6% (95% CI, 69.5-94.1%) and a specificity of 89.5% (95% CI, 66.9-98.7%) in mASPECTS.
CONCLUSIONS
mASPECTS might be useful for predicting neurological outcomes in patients after ECPR.
背景
我们评估了经过一些修改的 Alberta 卒中项目早期 CT 评分（ASPECTS）是否可用于预测体外心肺复苏（ECPR）后患者的神经功能结局。
方法
这是一项回顾性、多中心、观察性研究，纳入了 2010 年 5 月至 2016 年 12 月期间 ECPR 后 48 小时内行脑 CT 评估的无意识成年患者。通过 ROC 曲线评估 ASPECTS、双侧 ASPECTS（ASPECTS-b）和改良 ASPECTS（mASPECTS）以预测神经功能结局。主要结局为出院时的神经状态，采用脑功能分类（Cerebral Performance Categories，CPC）量表评估。
结果
在 58 例无意识患者中，25 例（43.1%）患者存活至出院。这 25 例幸存者中，19 例（32.8%）神经功能结局良好（CPC 评分 1 或 2 分）。CT 评分的观察者间信度极好。ASPECTS、ASPECTS-b 和 mASPECTS 的组内相关系数分别为 0.918（95%CI，0.865-0.950）、0.918（95%CI，0.866-0.951）和 0.915（95%CI，0.860-0.949）。mASPECTS 预测不良神经结局的预测性能优于 ASPECTS 或 ASPECTS-b（mASPECTS 与 ASPECTS 的 C 统计量为 0.922 比 0.812，p=0.004；mASPECTS 与 ASPECTS-b 的 C 统计量为 0.922 比 0.818，p=0.003）。mASPECTS 截断值为 25 时，对不良神经结局的敏感度为 84.6%（95%CI，69.5-94.1%），特异性为 89.5%（95%CI，66.9-98.7%）。
结论
mASPECTS 可能有助于预测 ECPR 后患者的神经功能结局。
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