Radiological eye deviation as a prognostic marker in patients post-cardiac arrest: a retrospective observational study.

Abstract

Objective: Eye deviation is recognized as a clinical indicator of brain function in acute brain injury. This study investigated the association between radiological eye deviation on brain computed tomography (CT) and neurological outcomes in post-cardiac arrest patients.

Methods: This single-center retrospective observational study included adult patients with out-of-hospital cardiac arrest of presumed medical cause who achieved return of spontaneous circulation and underwent brain CT within 24 hours between January 2012 and December 2022. Radiological lateral eye deviation angles were quantitatively measured on brain CT images. Multivariable logistic regression analysis was performed to identify independent predictors of poor neurological outcome at hospital discharge and in-hospital mortality. Receiver operating characteristic curve analysis was used to assess the diagnostic performance of eye deviation angles and serum biomarkers.

Results: Among 141 patients, 127 had poor neurological outcomes. Nonconjugate eye deviation was more frequent in the poor outcome group (71.7% vs. 42.9%) and showed a significant association in univariable analysis (odds ratio, 3.37; 95% confidence interval, 1.10-10.90; P=0.035), but it lost significance after multivariable adjustment. The diagnostic accuracy of the conjugate eye deviation angle was modest (area under the curve [AUC], 0.611) and inferior to that of serum S-100B protein (AUC, 0.790).

Conclusion: Radiological eye deviation on brain CT alone is insufficient to reliably predict neurological outcomes after cardiac arrest. Further large-scale studies incorporating multimodal approaches are warranted to clarify its prognostic value.