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. (November 2018)

• Record Type: Journal Article
• 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
• Is Part Of: Resuscitation. Volume 132(2018)
• Page Start: 21
• Page End: 28
• Publication Date: 2018-11
• Subjects: Heart arrest -- Patient outcome assessment -- Hypothermia -- Induced -- Gray matter; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2018.08.024
• Languages: English
• ISSNs: 0300-9572

Abstract

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.