scholarly journals Comparison of Prognostic Performance between Neuron-Specific Enolase and S100 Calcium-Binding Protein B Obtained from the Cerebrospinal Fluid of Out-Of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

2021 ◽  
Vol 10 (7) ◽  
pp. 1531
Author(s):  
Changshin Kang ◽  
Wonjoon Jeong ◽  
Jung Soo Park ◽  
Yeonho You ◽  
Jin Hong Min ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cardiac Arrest ◽  
Calcium Binding ◽  
Neuron Specific Enolase ◽  
Poor Outcome ◽  
The Poor ◽  
S100 Calcium Binding Protein ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Hospital Cardiac Arrest

We compared the prognostic performances of serum neuron-specific enolase (sNSE), cerebrospinal fluid (CSF) NSE (cNSE), and CSF S100 calcium-binding protein B (cS100B) in out-of-hospital cardiac arrest (OHCA) survivors. This prospective observational study enrolled 45 patients. All samples were obtained immediately and at 24 h intervals until 72 h after the return of spontaneous circulation. The inter- and intragroup differences in biomarker levels, categorized by 3 month neurological outcome, were analyzed. The prognostic performances were evaluated with receiver operating characteristic curves. Twenty-two patients (48.9%) showed poor outcome. At all-time points, sNSE, cNSE, and cS100B were significantly higher in the poor outcome group than in the good outcome group. cNSE and cS100B significantly increased over time (baseline vs. 24, 48, and 72 h) in the poor outcome group than in the good outcome group. sNSE at 24, 48, and 72 h showed significantly lower sensitivity than cNSE or cS100B. The sensitivities associated with 0 false-positive rate (FPR) for cNSE and cS100B were 66.6% vs. 45.5% at baseline, 80.0% vs. 80.0% at 24 h, 84.2% vs. 94.7% at 48 h, and 88.2% (FPR, 5.0%) vs. 94.1% at 72 h. High cNSE and cS100B are strong predictors of poor neurological outcome in OHCA survivors. Multicenter prospective studies may determine the generalizability of these results.

scholarly journals Intracranial Pressure Patterns and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Survivors after Targeted Temperature Management: A Retrospective Observational Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5697
Author(s):  
Hogul Song ◽  
Changshin Kang ◽  
Jungsoo Park ◽  
Yeonho You ◽  
Yongnam In ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Intracranial Pressure ◽  
Neurological Outcome ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Neurological Outcomes ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Hospital Cardiac Arrest

We aimed to investigate intracranial pressure (ICP) changes over time and the neurologic prognosis for out-of-hospital cardiac arrest (OHCA) survivors who received targeted temperature management (TTM). ICP was measured immediately after return of spontaneous circulation (ROSC) (day 1), then at 24 h (day 2), 48 h (day 3), and 72 h (day 4), through connecting a lumbar drain catheter to a manometer or a LiquoGuard machine. Neurological outcomes were determined at 3 months after ROSC, and a poor neurological outcome was defined as Cerebral Performance Category 3–5. Of the 91 patients in this study (males, n = 67, 74%), 51 (56%) had poor neurological outcomes. ICP was significantly higher in the poor outcome group at each time point except day 4. ICP elevation was highest between days 2 and 3 in the good outcome group, and between days 1 and 2 in the poor outcome group. However, there was no difference in total ICP elevation between the poor and good outcome groups (3.0 vs. 3.1; p = 0.476). All OHCA survivors who had received TTM had elevated ICP, regardless of neurologic prognosis. However, the changing pattern of ICP levels differed depending on the neurological outcome.

Abstract 9724: Variance of the Intracranial Pressure Over Time and Relationship With Neurologic Prognosis in Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Hogul Song ◽  
Yeonho You ◽  
Changshin Kang ◽  
Jung Soo Park
Keyword(s):  
Cardiac Arrest ◽  
Intracranial Pressure ◽  
Temperature Management ◽  
Poor Outcome ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Poor Outcomes ◽  
Over Time ◽  
Center Study

Introduction: Increased intracranial pressure (ICP) is one of the most serious post-cardiac arrest (CA) complications, and is associated with poor outcomes. However, only a few studies have described the changes in ICP over time according to neurologic outcomes during targeted temperature management (TTM) after CA. We aimed to investigate the changes in the ICP over time and neurologic prognosis in out-of-hospital cardiac arrest (OHCA) survivors who received TTM. Methods: This retrospective single-center study included OHCA survivors who underwent TTM between May 2018 and December 2020. ICP was measured immediately after the return of spontaneous circulation (ROSC) (Day 1), and after 24 h (Day 2), 48 h (Day 3), and 72 h (Day 4) by connecting a lumbar drain. The neurologic outcome was determined 3 months after the ROSC, and the Cerebral Performance Category (CPC) was dichotomized into good (CPC 1-2) and poor (CPC 3-5) outcomes. Results: We included 91 patients (males, 67; 74%); of whom 51 (56%) had a poor outcome. The ICP was significantly higher in the poor outcome group at each time point, except for Day 4. Moreover, the peak ICP levels were also higher in the poor outcome group (17.0 vs. 14.8; P = 0.002). The change in ICP levels was highest between Day 2 and Day 3 in the good outcome group, but between Day 1 and Day 2 in the poor outcome group. However, there was no difference in the total ICP change between the poor and good outcome groups (3.00 vs 3.09; P = 0.52). Using receiver operating characteristic analyses, the optimal cutoff values of the ICP levels for the prediction of poor outcomes were determined as: day 1, > 11.8; day 2, > 14.0; day 3, > 15.0; and day 4, > 14.8. Conclusions: All OHCA survivors who received TTM had an elevated ICP, regardless of the neurologic prognosis. However, peak ICP levels and the change in the ICP level on the first day after the ROSC was significantly higher in the poor outcome group. A prospective, multi-center study is required to confirm these results.

Abstract 9720: A New Window on a Cerebral Penumbra at Risk for a Secondary Ischemic Brain Injury in Post-Cardiac Arrest Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Changshin Kang ◽  
Jung Soo Park ◽  
Yeonho You
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Ischemic Brain Injury ◽  
Ischemic Brain ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group

Aim: This study aimed to investigate new target having potential neuroprotective effect against a secondary ischemic brain injury in post out-of-hospital cardiac arrest (OHCA) patients. Methods: This study analyzed physiological variables among OHCA patients with good or poor neurological outcomes despite having normal diffusion-weighted image findings before targeted temperature management (TTM). The factors affecting cerebral perfusion after OHCA, such as the time-weighted average (TWA) of arterial carbon dioxide (PaCO 2 ), oxygen (PaO 2 ), and mean arterial pressure (MAP); and the intracranial pressure (ICP) and quotient albumin ratio (Qalb), measured at 0 and 24 h from the return of spontaneous circulation (ROSC), were analyzed retrospectively using prospectively collected data. The primary outcome was the association between the factors and poor neurological outcome. Results: Fifty-one patients were included in this study. Among them, 11 had poor neurological outcomes. The pre-hospital factors such as anoxic time, initial rhythm; and TWA of physiological factors (PaCO 2 , PaO 2 , and MAP), were not significantly different between groups (p > 0.05). The inter-group comparisons of Qalb at 0 and 24 h were not significant (p > 0.05), whereas Qalb (median [interquartile range]) significantly increased from 0 to 24 h in the poor outcome group (0.007 [0.003 - 0.011] to 0.013 [0.005 - 0.029]; p = 0.04). Simultaneously, the ICP of the poor outcome group significantly increased over time (12.0 mmHg [8.1 - 13.0] to 16.0 mmHg [9.3 - 22.4]; p = 0.03), and higher than those of good outcome group at 24 h (11.0 mmHg [6.5 - 16.0] vs. 16.0 [9.3 - 22.4]; p < 0.01). Conclusion: Blood-brain barrier disruption and increasing ICP were apparent in OHCA patients who progressed into poor outcome despite no significant difference of brain injury before TTM compared with those of good outcome. These factors may be the key window on strategy to prevent the secondary ischemic brain injury after OHCA.

Abstract WP58: Correlating Stroke Volume with National Institute of Health Stroke Scale as a Means of Determining Patient Prognosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pamela J Zelnick ◽  
Liang Zhu ◽  
Louise D McCullough ◽  
Amrou Sarraj
Keyword(s):  
Patient Outcomes ◽  
Infarct Volume ◽  
Strong Predictor ◽  
Ratio Test ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group

Introduction: The NIH Stroke Scale (SS) is a widely used tool for directing treatment and predicting outcomes in Acute Ischemic Stroke (AIS). Severe strokes with high admission SS often correlate with long term disability, and as such, SS serves as a strong predictor of outcome. Final infarct volume (FIV) is also a pivotal predictor of stroke outcome. We aimed to evaluate the relationship between SS, FIV and outcome, and hypothesize that a combined approach evaluating both FIV and SS may more accurately correlate with patient outcomes. Methods: A single center, retrospective cohort study, examined AIS patients with large vessel occlusion (LVO) affecting the anterior circulation, between July 2004 and April 2013. Patients were stratified by treatment to 1) intra-arterial therapy, 2) IV tPA, 3) both or 4) neither. Primary outcomes measured were mRS at discharge and 90 days (good outcome mRS 0-2, poor 4-6). FIV was manually calculated from DWI obtained within the first 7 days of presentation. SS and FIV were compared against good and poor mRS outcomes using Wilcoxon rank sum test. Logistic regression analysis was used to evaluate the association between SS, FIV and mRS. Finally, likelihood ratio test was used to compare model fit between a model including SS alone and model including both SS and FIV. Results: In 332 patients, SS was significantly higher in the poor outcome group (17.3 ± 5.4) when compared to the good outcome group (13.0 ± 6.1) (p=0.0002). In the same analysis, FIVs were also larger in the poor outcome group (110.3 ± 113 cm3) when compared to the good outcome group (37.2 ± 68.3 cm3) (p<0.0001). A combined SS and FIV model correlated significantly better with discharge outcome than did SS alone (p=0.0015). Analysis of 182 patient outcomes at 90 days maintained similar findings, with SS (18 ± 5.9) and FIVs (115.4 ± 121.0 cm3) significantly higher in poor outcomes than in good outcomes; (13.0 ± 5.4) and (35.7 ± 38.2 cm3) respectively (p<0.0001). Combined SS and FIV model, again, was significantly better at modeling outcome at 90 days than was a model including SS alone (p=0.0044). Conclusions: A combined model including FIV and SS better correlates with clinical outcomes at discharge and 90 days in patients with AIS due to LVO, than does a model using SS alone.

scholarly journals Neuropsychiatric Traits Associated with Refractory Impulse Control Disorder in Parkinson’s Disease

2019 ◽  
Vol 19 (5-6) ◽  
pp. 171-177
Author(s):  
Ji-Hyun Choi ◽  
Jee-Young Lee ◽  
Beomseok Jeon ◽  
Seong-Beom Koh ◽  
Won Tae Yoon ◽  
...  
Keyword(s):  
Roc Curve ◽  
Impulse Control ◽  
Curve Analysis ◽  
Impulse Control Disorder ◽  
Obsessive Compulsive ◽  
Roc Curve Analysis ◽  
Poor Outcome ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group

Introduction: Impulse control disorder (ICD) in Parkinson’s disease (PD) is a critical nonmotor symptom with personality or neuropsychiatric traits contributing to ICD. Objective: This study aimed to identify predictive traits for persistent or paradoxical aggravation of ICD after dopamine agonist substitution therapy for ICD in PD. Methods: We conducted a case-control study using a database of a multicenter intervention trial for ICD in PD. The poor-outcome group was defined by showing paradoxical increases in ICD behaviors after the substitution of dopamine agonists with levodopa. We analyzed the pre-intervention personality traits associated with the poor outcome and also evaluated the risk traits for refractory ICD using a receiver-operating characteristic (ROC) curve analysis. Results: The poor-outcome group showed higher levels of anger expression (p =0.007) and obsessive-compulsive traits (p =0.009) compared with the good-outcome group at the pre-intervention state. In the ROC curve analysis, the Obsessive-Compulsive Inventory showed the highest area under the curve with 80.0% sensitivity and 74.3% specificity in discriminating against the poor-outcome group. Conclusions: Our results suggest that assessment of obsessive compulsiveness may be useful for predicting the refractoriness of ICD behaviors in planning an interventional treatment for ICD in PD.

scholarly journals Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage

2021 ◽  
Vol 12 ◽  
Author(s):  
Shufa Zheng ◽  
Haojie Wang ◽  
Guorong Chen ◽  
Huangcheng Shangguan ◽  
Lianghong Yu ◽  
...  
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Serum Levels ◽  
Poor Outcome ◽  
Microsurgical Clipping ◽  
The Poor ◽  
Preoperative Serum ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Fisher Grade ◽  
Average Serum

Introduction: We explored whether higher preoperative serum levels of lactate dehydrogenase (LDH) predicted outcome 3 months after surgery in patients with aneurysmal subarachnoid hemorrhage (aSAH) treated using microsurgical clipping in our institution.Methods: Patients with aSAH treated at our institution between 2010 and 2018 were enrolled. The following parameters were recorded: age, sex, smoking and drinking history, medical history, Hunt–Hess and Fisher grades, aneurysm location, aneurysm size, surgical treatment, delayed cerebral ischemia (DCI), intracranial infection, hydrocephalus, pneumonia, and preoperative serum LDH levels within 24 h of aSAH. We investigated whether preoperative serum LDH levels were associated with Hunt–Hess grade, Fisher grade, and functional neurological outcome.Results: In total, 2,054 patients with aSAH were enrolled, 874 of whom were treated using microsurgical clipping. The average serum LDH level (U/L) was significantly lower in the good outcome group (180.096 ± 50.237) than in the poor outcome group (227.554 ± 83.002; p &lt; 0.001). After propensity score matching, the average serum LDH level (U/L) was still lower in the good outcome group (205.356 ± 76.785) than in the poor outcome group (227.119 ± 86.469; p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.702 (95% confidence interval [CI]: 0.650–0.754; p &lt; 0.001). Based on the ROC curve, the optimal cutoff value for serum LDH levels as a predictor of poor 3-month outcome (modified Rankin Scale score &gt; 2) was 201.5 U/L. The results revealed that Hunt–Hess grade, Fisher grade, DCI, pneumonia, and serum LDH (&gt;201.5 U/L) were significantly associated with poor outcome. After propensity score matching, serum LDH levels &gt; 201.5 U/L were still considered an independent risk factor for poor outcome (odds ratio: 2.426, 95% CI = 1.378–4.271, p = 0.002). Serum LDH levels were associated with Hunt–Hess and Fisher grades and were correlated with functional neurological outcomes (p &lt; 0.001).Conclusions: Our findings showed that higher preoperative serum levels of LDH correlated with Hunt–Hess grade, Fisher grade, and neurological functional outcome, and predicted the outcome of aSAH treated by microsurgical clipping at 3 months, which was involved in the related mechanisms of early brain injury and showed its potential clinical significance in patients with aSAH.

scholarly journals Neurologic Prognostication by QEEG in Post Cardiac Arrest Patients with Therapeutic Hypothermia

2020 ◽  
Vol 38 (4) ◽  
pp. 260-271
Author(s):  
Sue Hyun Lee ◽  
Hyung Seok Ahn ◽  
Yong Hwan Kim ◽  
Hyang Woon Lee ◽  
Jung Hwa Lee
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Brain Regions ◽  
Critical Conditions ◽  
Relative Power ◽  
Good Outcome ◽  
Poor Outcome ◽  
Neurologic Outcomes ◽  
Poor Outcome Group ◽  
Outcome Group

Background: Post-cardiac arrest syndrome (PCAS) is one of the critical conditions which can result in a more serious brain injury. Early and accurate prognostication is crucial for deciding the patient’s therapeutic plan and setting the treatment goal. This study aimed to establish the prognostication values of quantitative electroencephalography (QEEG) in PCAS patients.Methods: We recruited 183 PCAS patients treated with therapeutic hypothermia. Electroencephalography (EEG) data within 72 hours after cardiac arrest (CA) and clinical data were collected. QEEG analysis including power spectral density (PSD) and connectivity analysis of default mode network (DMN) with imaginary coherence were performed.Results: There were significantly different patterns of PSD between neurologic good and poor outcome groups; absolute and relative power of the alpha 2 and beta 1 frequency (10-15 Hz) bands were increased in all brain regions of good outcome group. However, the relative power of the delta band and higher frequency bands over fast alpha (beta 3 and gamma bands over 20 Hz) were poor outcome markers. We found out that connectivity of DMN were significantly decreased in the poor outcome group compared with the good outcome group.Conclusions: These findings suggest that QEEG analysis could quantify and automate the interpretation of EEG. Furthermore, they can improve the prognostic values for neurologic outcomes relatively accurately and objectively in PCAS patients treated with hypothermia compared with traditional visual grading.

Prominent Hypointense Vessel Sign on Susceptibility-Weighted Imaging Is Associated with Clinical Outcome in Acute Ischaemic Stroke

2018 ◽  
Vol 79 (5-6) ◽  
pp. 231-239 ◽  
Author(s):  
Yiqi Wang ◽  
Tianming Shi ◽  
Bo Chen ◽  
Gaoping Lin ◽  
Yuyun Xu ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Predictive Ability ◽  
Artery Occlusion ◽  
Susceptibility Weighted Imaging ◽  
Poor Outcome ◽  
The Poor ◽  
Imaging Characteristics ◽  
Poor Outcome Group ◽  
Outcome Group

Background: Prominent hypointense vessel sign (PHVS) is visualized on susceptibility weighted-imaging (SWI) in acute ischaemic stroke (AIS). We aim to test if PHVS is associated with stroke outcome. Methods: Forty patients with acute middle cerebral artery occlusion were recruited. The presence of PHVS, cortical vessel sign (CVS), brush sign (BS) and susceptibility-diffuse weighted imaging mismatch (S-D mismatch) and Alberta Stroke Program Early CT Score (ASPECTS) on SWI were compared between the good outcome group (90-day modified Rankin scale [mRS] of 0–2) and the poor outcome group (mRS of 3–6). The receiver operating characteristic curves (ROC) were used to evaluate the predictive ability to poor outcome of above imaging characteristics. Results: The presence of PHVS, CVS, BS and S-D mismatch was significantly higher in the poor outcome group (p < 0.001, p = 0.001, p = 0.013, p = 0.014, respectively). SWI-ASPECTS was significantly lower in the poor outcome group (p = 0.002). Regression analysis revealed SWI-ASPECTS; the presence of PHVS and CVS were independently associated with poor outcome (OR 0.347, p = 0.012; OR 55.77, p = 0.004; OR 58.05, p = 0.005). ROC analysis showed that PHVS had the highest predictive value for poor outcome (AUC 0.783). Conclusions: The presence of PHVS, CVS and SWI-ASPECTS were associated with poor outcome in AIS. The presence of PHVS was the most effective radiographic marker for predicting outcome.

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