Gray matter to white matter ratio for predicting neurological outcomes in patients treated with target temperature management after cardiac arrest: A systematic review and meta-analysis
- Authors
- Na, Min Kyun; Kim, Wonhee; Lim, Tae Ho; Jang, Bohyoung; Cho, Youngsuk; Choi, Kyu-Sun; Shin, Hyun-Goo; Ahn, Chiwon; Lee, Juncheol; Kim, Jae Guk
- Issue Date
- Nov-2018
- Publisher
- ELSEVIER IRELAND LTD
- Keywords
- Heart arrest; Patient outcome assessment; Hypothermia; Induced; Gray matter
- Citation
- RESUSCITATION, v.132, pp 21 - 28
- Pages
- 8
- Journal Title
- RESUSCITATION
- Volume
- 132
- Start Page
- 21
- End Page
- 28
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/71045
- DOI
- 10.1016/j.resuscitation.2018.08.024
- ISSN
- 0300-9572
1873-1570
- Abstract
- Aims: This study aimed to evaluate the prognostic accuracy of the gray matter to white matter ratio (GWR) in predicting neurological outcomes in post-cardiac arrest patients treated with target temperature management. Data sources: We systematically searched MEDLINE and EMBASE (Search date: 09/13/2017). Included studies were those evaluating neurological outcomes using the cerebral performance categories scale. We performed a subgroup analysis based on the location of the measurement. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the risk of bias. Results: In total, 1150 patients from 10 observational studies were included. GWR of the basal ganglia (BG) average showed the highest value (area under the curve [AUC] 0.96, SE 0.02, Q 0.90) compared with the putamen/posterior limb of internal capsule (AUC 0.93, SE 0.05, Q 0.87), overall average (AUC 0.91, SE 0.02, Q 0.85), and cerebrum (AUC 0.89, SE 0.05, Q 0.82) for prognostic accuracy. Furthermore, the highest pooled diagnostic odd ratio of GWR for predicting poor neurological outcomes was shown for the BG average (21.00, 95% CI 6.85-64.40) followed by the overall average (20.71, 95% CI 9.53-44.98), putamen/posterior limb of internal capsule (16.08, 95% CI 4.36-59.23), and cerebrum (13.96, 95% CI 4.26-45.76). Conclusions: GWR in the early cranial computed tomography scan had high prognostic value in predicting poor neurological outcomes in post-cardiac arrest patients. The BG GWR had the highest prognostic accuracy when compared to other locations of the brain.
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