An Changjoo, You Yeonho, Park Jung Soo, Min Jin Hong, Jeong Wonjoon, Ahn Hong Joon, Kang Changshin, Yoo Insool, Cho Yongchul, Ryu Seung, Lee Jinwoong, Kim Seung Whan, Cho Sung Uk, Oh Se Kwang, Lee In Ho
Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.
Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.
Resuscitation. 2020 Dec;157:202-210. doi: 10.1016/j.resuscitation.2020.08.130. Epub 2020 Sep 12.
We presented the cut-off value of a diffusion-weighted image (DWI) scoring system to predict poor neurologic outcome using DWI taken 72-96 h after out-of-hospital cardiac arrest (OHCA) patients underwent target temperature management (TTM).
This was a prospective single-centre observational study, conducted from March 2018 to April 2020 in OHCA patients after TTM. Neurological status was assessed 6 months after return of spontaneous circulation (ROSC) using the Glasgow-Pittsburgh cerebral performance categories (CPC) scale. CPC of 1-2 demonstrated good neurologic outcomes whilst a CPC of 3-5 was related to poor neurologic outcomes. The receiver operating characteristic curves and DeLong method were used to evaluate the cut-off value of the DWI scoring system to predict poor neurologic outcome.
The good and poor neurologic outcome groups consisted of 38 (54.3%) and 32 (45.7%) patients, respectively. The area under the receiver operating characteristic curve (AUROC) of the overall, cortex, deep grey nuclei, and cortex plus deep grey nuclei scores, white matter, brainstem, and cerebellum measured 72-96 h after ROSC were 0.96, 0.96, 0.97, 0.96, 0.95, 0.95, and 0.93 respectively. For 100.0% specificity to predict poor neurologic outcome, the overall scores of the DWI scoring system measured 72-96 h after ROSC with a cut-off value of 52 had a sensitivity of 81.3% (95% CI: 63.6-92.8).
This study demonstrated that the DWI scoring systems measured between 72 and 96 h after ROSC were valuable tools to predict poor neurologic outcome in post-OHCA patients treated with TTM.
我们提出了一种弥散加权成像（DWI）评分系统的临界值，用于在院外心脏骤停（OHCA）患者接受目标温度管理（TTM）后72 - 96小时获取的DWI图像来预测不良神经功能结局。
这是一项前瞻性单中心观察性研究，于2018年3月至2020年4月对接受TTM后的OHCA患者进行。在自主循环恢复（ROSC）6个月后，使用格拉斯哥 - 匹兹堡脑功能分类（CPC）量表评估神经功能状态。CPC为1 - 2表示神经功能结局良好，而CPC为3 - 5则与不良神经功能结局相关。采用受试者工作特征曲线和德龙方法来评估DWI评分系统预测不良神经功能结局的临界值。
神经功能结局良好组和不良组分别有38例（54.3%）和32例（45.7%）患者。ROSC后72 - 96小时测量的总体、皮质、深部灰质核、皮质加深部灰质核评分、白质、脑干和小脑的受试者工作特征曲线下面积（AUROC）分别为0.96、0.96、0.97、0.96、0.95、0.95和0.93。为了以100.0%的特异性预测不良神经功能结局，ROSC后72 - 96小时测量的DWI评分系统总体评分，临界值为52时，敏感性为81.3%（95%CI：63.6 - 92.8）。
本研究表明，ROSC后72至96小时测量的DWI评分系统是预测接受TTM治疗的OHCA后患者不良神经功能结局的有价值工具。
