Outcomes Of Eligible Patients Research Articles

Long-Term Outcome after Early Mammalian Target of Rapamycin Inhibitor-Based Immunosuppression in Kidney Transplant Recipients.

Background: The use of mammalian target of rapamycin inhibitors (mTORis) in kidney transplantation increases the risk of donor-specific human leukocyte antigen (HLA) antibody formation and rejection. Here, we investigated the long-term consequences of early mTORi treatment compared to calcineurin inhibitor (CNI) treatment. Methods: In this retrospective single-center analysis, key outcome parameters were compared between patients participating in randomized controlled immunosuppression trials between 1998 and 2011, with complete follow-up until 2018. The outcomes of eligible patients on a CNI-based regimen (n = 384) were compared with those of patients randomized to a CNI-free mTORi-based regimen (n = 81) and 76 patients randomized to a combination of CNI and mTORi treatments. All data were analyzed according to the intention-to-treat (ITT) principle. Results: Deviation from randomized immunosuppression for clinical reasons occurred significantly more often and much earlier in both mTORi-containing regimens than in the CNI treatment. Overall patient survival, graft survival, and death-censored graft survival did not differ between the treatment groups. Donor-specific HLA antibody formation and BPARs were significantly more common in both mTORi regimens than in the CNI-based immunosuppression. Conclusions: The tolerability and efficacy of the mTORi treatment in kidney graft recipients are inferior to those of CNI-based immunosuppression, while the long-term patient and graft survival rates were similar.

Predicting Motor Outcome and Quality of Life After Subthalamic Deep Brain Stimulation for Parkinson's Disease: The Role of Standard Screening Measures and Wearable-Data.

Standardized screening for subthalamic deep brain stimulation (STN DBS) in Parkinson's disease (PD) patients is crucial to determine eligibility, but its utility to predict postoperative outcomes in eligible patients is inconclusive. It is unknown whether wearable data can contribute to this aim. To evaluate the utility of universal components incorporated in the DBS screening, complemented by a wearable sensor, to predict motor outcomes and Quality of life (QoL) one year after STN DBS surgery. Consecutive patients were included in the OPTIMIST cohort study from two DBS centers. Standardized assessments included a preoperative Levodopa Challenge Test (LCT), and questionnaires on QoL and non-motor symptoms including cognition, psychiatric symptoms, impulsiveness, autonomic symptoms, and sleeping problems. Moreover, an ambulatory wearable sensor (Parkinson Kinetigraph (PKG)) was used. Postoperative assessments were similar and also included a Stimulation Challenge Test to determine DBS effects on motor function. Eighty-three patients were included (median (interquartile range) age 63 (56-68) years, 36% female). Med-OFF (Stim-OFF) motor severity deteriorated indicating disease progression, but patients significantly improved in terms of Med-ON (Stim-ON) motor function, motor fluctuations, QoL, and most non-motor domains. Motor outcomes were not predicted by preoperative tests, including covariates of either LCT or PKG. Postoperative QoL was predicted by better preoperative QoL, lower age, and more preoperative impulsiveness scores in multivariate models. Data from the DBS screening including wearable data do not predict postoperative motor outcome at one year. Post-DBS QoL appears primarily driven by non-motor symptoms, rather than by motor improvement.

Oncology patients through the eyes of their physicians.

e18757 Background: There is a continuous need for optimizing and rationalizing cancer care according to national and international guidelines. The aim of the survey is exploring the thoughts and expectations of oncologists worldwide regarding their patients' management and prognosis and the factors affecting these expectations. This survey shed light on the oncologists' side of the relationship with their patients, which is often ignored. Methods: This is an observational cross-sectional study via an online pre-tested self-administered survey, targeting subspecialties of Oncologists across the world. Results: Among 929 Oncologists who completed the survey, 50.7% worked at University hospitals. They came from 17, 27, 23 and 14 countries in Africa, Asia and Australia, Europe, and the Americas respectively. Our results showed that, 58.7% thought stage of the disease is the most important factor affecting the prognosis. Additionally, 34.4%, 21.4% and 14.2% agreed that the 2nd most important factor was Performance status, stage of the disease, and disease pathology and immunohistochemistry respectively. Also 63% agreed that targeted therapy improves their expectations of the outcomes in eligible patients. While, 56% agreed that Immunotherapy improves their expectations. Only 42.3% indicated that they always inform patients of the detailed management plan and only 20.7% agreed that they always inform advanced cases about their incurable disease. Moreover, 52% usually expect the patients to fully understand the detailed management plan, but only 7% always expect that. The main factor affecting this is the patients’ education level as indicated by 76% of the respondents. The 2nd leading cause is that patients usually have some degree of denial as indicated by 35%, followed by patients’ unrealistic expectations as indicated by 30% of oncologists. Results also showed that 63.5% always inform their patients about all adverse events of their therapy directly, and 59% agreed that patients usually accept them, but only 6.5% indicated that patients always accept them. The fear of death or possible disabilities are the main factors causing some patients to reject these adverse events as indicated by 52%, while 31% thought fear of the looming social or financial difficulties is the main cause. The majority agreed that patients are either always (33%) or usually (46.9%) open to their case being discussed in Multidisciplinary clinics. Contrarily, only 5.3% indicated patients are always open to being referred to Psychiatrists. The majority agreed that patients are open to being referred to nutritionists or non-oncology physicians. However, only 19% and 7% agreed that patients are always open to being referred to Palliative care and Hospice respectively. Conclusions: The survey shows that oncologists worldwide have consistent evidence-based prognosis. Contrary to that, it shows widely varying perceptions regarding the patients’ reactions, due to variable factors.

Impact of Thiotepa-Based Autologous Hematopoietic Cell Transplantation in Primary Central Nervous System Lymphoma in First Complete Remission: A University of California Hematologic Malignancies Consortium Retrospective Analysis

BackgroundThe choice between nonmyeloablative chemotherapy (NMA-C) or autologous hematopoietic cell transplantation (autoHCT) as consolidation in primary central nervous system lymphoma (PCNSL), and timing of autoHCT differs among centers. We aimed to clarify these points. MethodsWe retrospectively analyzed PCNSL adult patients who received consolidation in CR1 or underwent autoHCT during their treatment course. Cohort A included those who underwent autoHCT in CR1, cohort B included those who underwent NMA-C in CR1, and cohort C included patients who underwent autoHCT in CR2+. We compared cohorts A and B, and cohorts A and C. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival (PFS), treatment-related mortality (TRM) and cumulative incidence of relapse (CIR). Results36 patients were included in cohort A, 30 in cohort B, and 14 in cohort C. The 5-year OS for cohorts A vs B and vs C were 90.7% vs 62.8% (P = .045) and vs 77.9% (P = .32), respectively. The 5-year PFS from diagnosis for cohorts A vs B was 87.8% vs 37.3% (P < .001). The 5-year PFS from autoHCT for cohorts A vs C was 87.6% vs 58.4% (P = .023). The 5-year TRM and CIR in cohorts A vs B was 9.4% vs 9.5% (P = .674), and 2.9% vs 53.2% (P < .001), respectively. The 5-year TRM and CIR in cohorts A vs C from the time of autoHCT was 9.5% vs 22.1% (P = .188), and 2.9% vs 19.5% (P = .104), respectively. ConclusionDespite the limitations, thiotepa-based autoHCT in CR1 appears to improve outcomes in eligible patients with PCNSL.

1153 SODIUM GLUCOSE COTRANSPORTER-2 INHIBITORS ELIGIBILITY IN PATIENTS WITH HEART FAILURE ACROSS THE SPECTRUM OF EJECTION FRACTION

Abstract Background Large randomized clinical trials demonstrated that sodium–glucose co-transporter-2 (SGLT2) inhibitors reduced adverse cardiovascular outcomes in patients with heart failure (HF) with both reduced (HFrEF) and preserved (HFpEF) ejection fraction. Despite the high potential to change clinical practice, the strict trial selection criteria might reduce external validity of these findings. Purpose The aim of the study was to evaluate the proportion of outpatients with HF that would be eligible for SGLT2 inhibitors across the spectrum of left ventricular ejection fraction (LVEF) in a contemporary real-world population. Methods We retrospectively evaluated patients with chronic stable HF followed-up at the outpatient clinic of our institution. HFrEF (LVEF &amp;lt;40%) patients’ eligibility was assessed according to the entry criteria of DAPA-HF (dapagliflozin) and EMPEROR-Reduced (empagliflozin) trials and to US Food and Drug Administration (FDA) label criteria (only dapagliflozin). In HFpEF group (LVEF&amp;gt;40%), Eligibility to SGLT2 inhibitors was based both strict and pragmatic (most likely influencing treatment decisions in clinical practice) EMPEROR- Preserved inclusion/exclusion criteria (empagliflozin). Results A total of 642 HF patients (441 HFrEF; 201 HFpEF) was studied. Among HFrEF patients, according to the major inclusion and exclusion criteria from DAPA-HF and EMPEROR-Reduced trials, 198 (45%) patients would be candidates for initiation of both dapagliflozin and empagliflozin, 61 (14%) would be eligible only to dapagliflozin and 23 (5%) only to empagliflozin, On the other hand, in HFpEF patients, 125 (62%) patients would be candidates for initiation of empagliflozin based on the EMPEROR-Preserved trial selection criteria. No significant differences were found between diabetic and non-diabetic patients in both HFrEF (p=0.23) and HFpEF (p=0.37). In patients not suitable for gliflozins treatment the major determinant of ineligibility was the failure to achieve the predefined NTproBNP inclusion threshold. Excluding NTproBNP as per FDA label criteria, dapagliflozin eligibility increased to 86%. Similarly, applying EMPEROR-Preserved criteria most likely influencing treatment decisions in clinical practice (symptomatic HF; eGFR &amp;lt;20 mL/min/1.73 m2; symptomatic hypotension; history of ketoacidosis) the proportion of HFpEF patients potentially eligible to empagliflozin rose to 85%. Conclusions In our real-world analysis the proportion of HF patients potentially candidate for initiation of SGLT2 inhibitors is consistent across the entire spectrum of LVEF. Our findings might herald an extensive use of gliflozins in HF treatment, with a consequent strong beneficial impact on cardiovascular outcomes in eligible patients.

Impact of Trial Eligibility Criteria on Outcomes of 1,245 Patients with Follicular Lymphoma Treated in the Real-World Setting: A Danish Population-Based Study

Background For most patients, follicular lymphoma (FL) is an incurable, chronic disease and time in remission gradually becomes shorter with each new treatment intervention. Survival after 1st line immunochemotherapy is excellent overall, but outcomes for the minority with progression of disease within 24 months of first line treatment (POD24) are dismal. The 10-year overall survival (OS) rate in clinical trials of 1st line immunochemotherapy is around 80%, making further survival improvements difficult to achieve. However, the unmet medical needs could be more substantial for the group of patients which are excluded from trial participation due to violation of inclusion/exclusion criteria. Aim To investigate the impact of commonly used in/exclusion criteria in clinical trials on the OS of real-world patients with FL. Methods This study is based on a nationwide population-based lymphoma registry (LYFO). Patients ≥18 years with grade 1-3 FL (including 3B as grade 3 is not subcategorized in LYFO) and diagnosed between 2000-2018 were included if they had received 1st line treatment with R-CVP, R-CHOP or R-Bendamustin within 90 days of date of diagnosis. The eligibility criteria from following trials were applied to the patient population: GALLIUM, RELEVANCE, BRIGHT, and StiL NHL1. First, patients were selected to match the age group and disease stages relevant for the trials. The impact of performance status (ECOG PS), hemoglobin, platelets, neutrophil count (estimated as total WBC-lymphocyte count), liver function (ALAT, bilirubin) and kidney function (estimated by eGFR) on OS were assessed. Shapley-values measuring an average decrease in 5-year restricted mean survival difference by omitting a criterion were used to assess the impact of the inclusion criteria on the OS difference between eligible and ineligible patients. Results A total of 3,702 adults were diagnosed with FL, of those 1,183 were included in the study. Median age was 63 and male:female ratio was 1.1. Firstline treatments were R-Bendamustin (20.3%), R-CVP (35.4%) and R-CHOP (44.3%), proportion treated with R-Bendamustin increasing to 50% after 2016. Rituximab maintenance was used in 47.3%. The 5-year OS for all patients was 82% with no differences between patients treated with R-Bendamustine (5-year OS, 79%, CI: 73-86%), R-CVP (81%, CI: 77-85%) and R-CHOP (84%, CI: 80-87%) (Table 1). 1,036 patients were relevant for the GALLIUM trial based on age (≥18 years) and Ann Arbor disease stage (2 with bulky disease, 3 or 4) alone. Of 870 patients with available data on in/exclusion criteria, 778 (89%) were trial eligible, 92 (11%) were ineligible. The outcome of eligible patients was superior to the outcome of ineligible patients with 5-year OS of 83% vs 56% (P<0.0001, Fig. 1) with results similar when stratifying on treatment. Adjustments for age differences between eligible and ineligible patients did not impact results (5-year OS difference of 24%, CI: 13-35%). Results were consistent for the other trials with 5-year OS for eligible and ineligible patients of 83 vs 62% for RELEVANCE (P<0.0001), 84% vs 66% for BRIGHT (P<0.0001) and 81% vs 53% for StiL NHL1 (P<0.0001). POD24 was observed more frequently in ineligible patients (except in RELEVANCE), even though deaths without disease progression were treated as a competing risk to reduce impact of comorbidity related deaths. According to the Shapley-values, ECOG PS (ranging from 5.64 to 9.98 months) and creatinine (ranging from 1.27 to 11.0 months) were the most important contributors to the observed OS differences between eligible and ineligible patients. The main reason for ineligibility for GALLIUM, RELEVANCE and BRIGHT was low creatinine clearance with 38%, 69% and 47% of ineligible patients violating this criterion respectively (24% in StiL NHL1). In StiL NHL1, 45% and 39% of ineligible patients did not fulfill the ECOG PS and ALAT criteria. Conclusions This study shows that commonly used in/exclusion criteria in clinical trials of FL lead to exclusion of a group of patients with 5-year OS outcomes significantly worse than trial eligible patients. A higher proportion of POD 24 events in the group of ineligible patients also suggests that disease control was inferior in those patients. Collectively, these results show that a high unmet need remains for better 1st line therapies for the minority of FL patients ineligible for clinical trials with narrow in/exclusion criteria. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Implementation of an Evidence-Based Prenotification Process for Patients With Stroke to Improve Neurological Outcomes.

BACKGROUND: Endovascular mechanical thrombectomy can improve clinical outcomes in eligible patients with acute ischemic stroke (AIS), but its efficacy is time dependent. This quality improvement project aimed to examine whether a revised evidence-based neurological deficit algorithm initiated in the emergency department could reduce door-to-groin puncture time to less than 90 minutes and improve neurological outcomes in AIS patients who received mechanical thrombectomy. METHODS: Retrospective chart reviews occurred between September 2020 and April 2021, which included 25 patients. Clinical and time data were collected from AIS patients who were 18 years and older, presented for care with AIS symptoms, and deemed candidates for thrombectomy for a period of 6 months. A revised neurological deficit algorithm was initiated, and education was presented to appropriate staff. Postintervention chart reviews occurred from August 2021 to January 2022, which included 25 patients. RESULTS: Door-to-groin puncture time did not improve to less than 90 minutes; however, there was a slight improvement in time from 106 minutes in the preintervention to 98 minutes in the postintervention ( P = .534). Although the outcome measures were not clinically significant, there was a statistically significant decrease in response time to acute stroke call down ( P < .01). Door-to-computed tomography also improved, which was 14.42 minutes for the preintervention group and 5.25 minutes for the postintervention group ( P < .001). Finally, the mean National Institutes of Health Stroke Scale on discharge for the preintervention group was 11.92, and that of the postintervention group was 6.05 on discharge ( P < .01). CONCLUSIONS: Implementation of the revised neurological deficit algorithm did not decrease the door-to-groin puncture time to less than 90 minutes. After implementation of the revised neurologic deficit algorithm, there were single variable improvements in several benchmarks, and this is a starting point for future quality improvement projects.

Double-dose icotinib may induce the emergence of the EGFR exon 20 T790M mutation in non-small cell lung cancer patients harboring EGFR-sensitive mutation.

BackgroundAcquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) inevitably occurs in non-small cell lung cancer (NSCLC) patients harboring EGFR-sensitive mutations. There are approximately half of the patients who developed resistance to EGFR-TKIs treatment, the mechanism of which remains undiscovered. We occasionally found that double-dose icotinib as further-line salvage treatment may induce the emerging mutation of EGFR exon 20 T790M in NSCLC patients. The present study, therefore, was conducted to explore the probability of the emerging T790M mutation after exposure to double-dose icotinib in metastatic NSCLC patients.Patients and MethodsMetastatic NSCLC patients who received double-dose icotinib as salvage treatment after progression on first-generation TKIs and systematic chemotherapy were screened. Thereafter, patients who received a repeated next-generation sequencing (NGS) test with tumor sample were further enrolled. The procedure of NGS was performed with the standard criteria. Finally, the clinical characteristics, treatment procedures, and outcomes of eligible patients were reviewed and presented.ResultsThree patients have been detected with the emerging T790M mutation after double-dose icotinib exposure, with a mutation frequency of 19.6%, 8.2%, and 87.5%. During the treatment of targetable TKIs including almonertinib or osimertinib, partial response was observed in two patients, and stable disease was observed in the other. The progression-free survival by targetable TKIs for the patients was 3.7+ months (still in extension), 4.9+ months (still in extension), and 6.3 months. Manageable adverse events were observed during the treatment of TKIs.ConclusionThe results of the present study revealed that the emerging EGFR exon 20 T790M mutation might be induced by double-dose icotinib exposure in further-line treatment. Patients with the emerging T790M mutation responded well to the treatment of targetable TKIs including almonertinib or osimertinib.

Cardiorenal outcomes in eligible patients referred for bariatric surgery.

Bariatric surgery is associated with reduced atherosclerotic cardiovascular disease (CVD) and heart failure hospitalization in people with type 2 diabetes (T2D) and those with prior CVD. Most patients undergoing bariatric surgery do not have T2D or CVD. Many otherwise eligible patients do not have surgery because of self-exclusion. Clinical outcomes in these groups are less established. This study retrospectively assessed cardiorenal outcomes in 8,568 patients after acceptance of referral for surgery. A total of 63.8% patients did not undergo surgery. After multivariate adjustment for sex, age, BMI, income quintile, distance from hospital, hypertension, T2D, and CVD, hazard ratios (HR) for the primary (incident myocardial infarction, stroke, heart failure hospitalization, and death; HR = 0.52, 95% CI: 0.4-0.66) and secondary CVD outcomes (primary outcomes and coronary/carotid revascularization; HR = 0.53, 95% CI: 0.42-0.67) were lower in the surgery cohort. This reduction was seen in those with (primary: HR = 0.45, 95% CI: 0.32-0.63, secondary: HR = 0.47, 95% CI: 0.34-0.65) and without T2D (primary: HR = 0.61, 95% CI: 0.42-0.88, secondary: HR = 0.53, 95% CI: 0.42-0.67). Reduced kidney disease (HR = 0.46, 95% CI: 0.22-0.92) but increased liver disease hospitalization (HR = 2.5, 95% CI: 1.45-4.27) was observed with surgery. Non-progression to surgery associates with increased CVD despite low baseline prevalence of CVD. The cardiorenal benefits of bariatric surgery warrant confirmation in a well-powered randomized clinical trial.

The current status of early use of oral β-blockers in patients with acute coronary syndrome and the association with the in-hospital outcomes

Objective: To analyze the status of early use of oral β-blocker and its relationship with in-hospital outcomes in eligible patients with acute coronary syndrome (ACS). Methods: The study was based on the Improving Care for Cardiovascular Disease in China (CCC)-ACS project. The data of ACS patients that collected during 2014 to 2019 from 230 collaborating hospitals across China were analyzed. Propensity score matching method and Cox multivariate regression analysis were used to analyze the association between early use of oral β-blocker and in-hospital outcomes within 15 days. Results: A total of 38 663 eligible ACS patients were included in this study. The mean age was (57.0±9.0), and 78.8% of the ACS patients (30 470/38 663) were male. The proportion of early use of oral β-blockers was 64.9% (25 112/38 663), but varied substantially, in the 230 hospitals with a range from 0 to 100%. Compared with the patients no early use of oral β-blocker, the patients receiving early oral β-blocker had significantly lower incidence of major cardiovascular adverse events (MACEs) (3.4% (395/11 536) vs. 2.9%(339/11 536), P=0.036)and less occurrences of heart failure (2.7% (316/11 536) vs. 2.1% (248/11 536), P=0.004). Multivariate Cox regression analyses showed the patients receiving early oral β-blocker had 15.5%, 23.1%, and 35.3% lower risks of MACEs, heart failure and cardiogenic shock respectively than the patients no early oral β-blocker. Conclusions: Compared with the patients no early oral β-blocker, the patients receiving early oral β-blocker had lower risks of MACEs events, heart failure and cardiogenic shock. However, the early use of oral β-blocker in ACS patients was generally insufficient with huge differences among different hospitals in China.

Sole adjuvant intraoperative breast radiotherapy in Taiwan: a single-center experience

IntroductionIntraoperative radiotherapy (IORT) is more convenient than standard whole breast external beam radiotherapy (EBRT) as a sole adjuvant radiotherapy for breast cancer. The impact of age on breast cancer course and treatment strategy is still under investigation, and the peak age for breast cancer in Taiwan is much younger than that in Western countries. We aimed to review the oncological outcomes of sole IORT compared with standard EBRT in a country with younger breast cancer patients.Patients and methodsWe reviewed patients with invasive breast cancer who received breast-conserving surgery (BCS) from September 2014 to December 2016. The clinicopathologic characteristics and oncological outcomes of eligible patients who received EBRT or IORT as sole adjuvant radiotherapy after BCS were collected and reviewed.ResultsA total of 170 patients were enrolled with a mean follow-up time of 3.53 ± 0.82 years. The risk of locoregional recurrence was 2.44% for EBRT versus 10.64% for IORT (p = 0.024). IORT was a significant risk factor of locoregional recurrence (p = 0.005). The hazard ratios (HRs) for locoregional recurrence in the IORT group compared with the EBRT group were significantly higher in non-suitable risk group patients (HR = 7.02, p = 0.009) and in patients under 50 years old (HR = 10.42, p = 0.011).ConclusionsLocoregional recurrence was significantly higher in patients who received IORT than in those who underwent EBRT. IORT should not be used alone in patients under 50 years old who do not belong to a suitable group.

Abstract WMP5: Predictors and Outcome of Eligible Patients for Late Endovascular Treatment: Real Life Analysis From a Comprehensive Stroke Center

Background and Aims: The DAWN and DEFUSE-3 trials demonstrated the benefit of late endovascular treatment (EVT) in acute ischemic stroke (AIS) patients. We aimed to identify indipendent predictors for late EVT eligibility according to trials and to more liberal criteria. Moreover, we compared the clinical outcome of patients treated with late EVT and fulfilling each set of selection criteria. Material and Methods: In the ASTRAL registry (2003-2017), we calculated the proportion of late (6-24 hours) EVT eligibility according to trials and to more liberal criteria (the latter including M2 occlusion, lower NIHSS on admission, and using ASPECTS for core volume estimation). We searched for clinical and radiological variables associated with late EVT eligibility using a multivariate regression. We also analysed functional independence (modified Rankin Scale (mRS) 0-2) at 3 months for patients treated with late EVT. Results: Out of 925 late arriving AIS patients with complete data, 2.5% were eligible with DAWN, 5.1% with DEFUSE-3 and 11.1% with liberal criteria. Variables associated with late EVT eligibility are shown in Table 1. Functional independence was achieved in 6/14 (42.9%) of the trial-eligible, and in 11/27 (40.7%) of the liberal-eligible patients treated with EVT. After adjustment for age, NIHSS, vigilance impairment, ASPECTS and acute glucose, DEFUSE-3-like patients showed better outcome than DAWN-like and liberal criteria selected patients (OR 4.45; 95%CI 1.11-17.85). Conclusion: Among late arriving AIS patients, only 5% were eligible for late EVT based on trials criteria. Radiological variables were stronger than clinical predictors to identify DAWN and DEFUSE-3 patients. In the small cohort of effectively treated patients, satisfying DEFUSE-3 was associated with the most favourable outcome.

Neurologic Prognosis in Cardiac Arrest Patients Treated With Therapeutic Hypothermia

Therapeutic hypothermia is now commonly used to improve neurologic outcomes in eligible patients after cardiac arrest. The physiologic effects of cooling and pharmacologic effects of sedatives and neuromuscular blocking agents can affect the clinical exam and neurophysiologic findings. This can lead to uncertainty in neurologic prognostication. In this article, we review data on assessing prognosis in patients treated with therapeutic hypothermia. Features of the clinical examination, neurophysiologic testing (including somatosensory-evoked potentials and electroencephalography), serum/cerebrospinal fluid biomarkers and neuroimaging can be used to help predict prognosis. However, no single test can predict poor prognosis with absolute certainty. Given the features that help to predict poor, indeterminate, or good outcome, we provide practical advice in assessing neurologic prognosis after cardiac arrest in patients treated with therapeutic hypothermia. The American Academy of Neurology practice parameters for assessing prognosis after cardiac arrest may not be accurate for patients treated with therapeutic hypothermia. Application of these guidelines may lead to overly pessimistic prognostication and premature withdrawal of care. If uncertainty exists regarding the prognosis in a given patient after cardiac arrest, additional time should be allowed to pass, as patients may ultimately recover with good neurologic outcome.