根据缺氧缺血性脑损伤的严重程度预测院外心脏骤停幸存者早期头部计算机断层扫描 (CT) 中灰白质比值的神经功能预后。

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
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引用次数: 0

摘要

背景:缺氧缺血性脑损伤(HIBI)是院外心脏骤停(OHCA)的常见并发症:我们研究了使用早期头部计算机断层扫描(HCT)测量的灰白质比值(GWR)是否与基于缺氧缺血性脑损伤严重程度的 OHCA 幸存者神经系统预后相关:这项回顾性多中心研究纳入了在自主循环恢复后 2 小时内接受 HCT 扫描的成人昏迷 OHCA 幸存者。HIBI严重程度采用修订后的心脏骤停后治疗性低温综合征(rCAST)量表(低度、中度和重度)进行评估。OHCA发生6个月后,脑功能分级为3至5级,即为不良神经功能结果:在354名患者中,27%为女性,224人(63.3%)的神经系统结果不佳。严重程度分布为低度19.5%、中度47.5%和重度33.1%。预测 rCAST 严重程度(低度、中度和重度)的 GWR 值的接收器操作曲线下面积分别为 0.52、0.62 和 0.79。重度组的预测性能明显高于中度组(p = 0.02)。多变量逻辑回归分析显示,中度组的 GWR 值与神经系统不良预后之间存在显著关联(调整后的几率比 = 0.012,95% CI 0.0-0.54,p = 0.02):在这项队列研究中,使用早期 HCT 测量的 GWR 值在根据 HIBI 严重程度预测神经系统预后方面存在差异。此外,中度组的 GWR 与不良的神经系统预后有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Grey-to-White Matter Ratio Values in Early Head Computed Tomography (CT) as a Predictor of Neurologic Outcomes in Survivors of Out-of-Hospital Cardiac Arrest Based on Severity of Hypoxic-Ischemic Brain Injury

Background

Hypoxic-ischemic brain injury (HIBI) is a common complication of out-of-hospital cardiac arrest (OHCA).

Objectives

We investigated whether grey-to-white matter ratio (GWR) values, measured using early head computed tomography (HCT), were associated with neurologic outcomes based on the severity of HIBI in survivors of OHCA.

Methods

This retrospective multicenter study included adult comatose OHCA survivors who underwent an HCT scan within 2 h after the return of spontaneous circulation. HIBI severity was assessed using the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) scale (low, moderate, and severe). Poor neurologic outcomes were defined as Cerebral Performance Categories 3 to 5 at 6 months after OHCA.

Results

Among 354 patients, 27% were women and 224 (63.3%) had poor neurologic outcomes. The distribution of severity was 19.5% low, 47.5% moderate, and 33.1% severe. The area under the receiver operating curves of the GWR values for predicting rCAST severity (low, moderate, and severe) were 0.52, 0.62, and 0.79, respectively. The severe group had significantly higher predictive performance than the moderate group (p = 0.02). Multivariate logistic regression analysis revealed a significant association between GWR values and poor neurologic outcomes in the moderate group (adjusted odds ratio = 0.012, 95% CI 0.0–0.54, p = 0.02).

Conclusions

In this cohort study, GWR values measured using early HCT demonstrated variations in predicting neurologic outcomes based on HIBI severity. Furthermore, GWR in the moderate group was associated with poor neurologic outcomes.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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