Prediction Of Neurological Outcome Research Articles

PCT levels as predictors of neurological outcome in patients with cardiac arrest treated with therapeutic hypothermia: A retrospective study

Background/objective: Procalcitonin (PCT) is a biomarker that is widely used to identify bacterial infections, confirm a diagnosis of sepsis, to monitor response to antibacterial therapy, and to assess general inflammatory response. Our goal was to assess the use of PCT levels as predictors of neurological outcome in patients who suffered cardiac arrest (CA) and underwent mild therapeutic hypothermia at 32°C for a period of 24h (TH).

Neuron-specific enolase is a strong predictor of neurological outcomes in cardiac arrest survivors treated with endovascular hypothermia

Objective: Outcomes prediction after cardiac arrest remains challenging despite the rapid progress in the management of cardiac arrest survivors (CAS) during the past years. The prognostic value of neuron-specific enolase (NSE) in CAS treated with endovascular hypothermia is still not fully understood.

Regional cerebral oxygen saturation after cardiac arrest in 60 patients—A prospective outcome study

IntroductionNon-invasive near-infrared spectroscopy (NIRS) offers the possibility to determine regional cerebral oxygen saturation (rSO2) in patients with cardiac arrest. Limited data from recent studies indicate a potential for early prediction of neurological outcome. MethodsSixty cardiac arrest patients were prospectively enrolled, 22 in-hospital cardiac arrest (IHCA) and 38 out-of-hospital cardiac arrest (OHCA) patients respectively. NIRS of frontal brain was started after return of spontaneous circulation (ROSC) during admission to ICU and was continued until normothermia. Outcome was determined at ICU discharge by the Pittsburgh Cerebral Performance Category (CPC) and 6 months after cardiac arrest. ResultsA good outcome (CPC 1–2) was achieved in 23 (38%) patients, while 37 (62%) had a poor outcome (CPC 3–5). Patients with good outcome had significantly higher rSO2 levels (CPC 1–2: rSO2 68%; CPC 3–5: rSO2 58%; p<0.01). For good and poor outcome median rSO2 within the first 24h period was 66% and 59% respectively and for the following 16h period 68% and 59% (p<0.01). Outcome prediction by area of rSO2 below a critical threshold of rsO2=50% within the first 40h yielded 70% specificity and 86% sensitivity for poor outcome. ConclusionOn average, rSO2 within the first 40h after ROSC is significantly lower in patients with poor outcome, but rSO2 ranges largely overlap between outcome groups. Our data indicate limited potential for prediction of poor outcome by frontal brain rSO2 measurements.

Neonatal seizures: magnetic resonance imaging adds value in the diagnosis and prediction of neurodisability

To determine the aetiological associations, neurological sequelae and role of magnetic resonance imaging (MRI) in term newborn infants with seizures. Cohort study of infants ≥37weeks' gestation delivered in a tertiary level centre, prospectively identified and followed longitudinally for 18-24months. An underlying aetiology was found in 95% of the 77 infants identified with seizures (3.0/1000 live births). The most common diagnosis was hypoxic-ischaemic encephalopathy (HIE) (65%), followed by neonatal stroke (12%). Nine infants died, 28 of the 68 survivors developed neurodevelopmental impairment (NDI), and 15 had recurrent seizures in the first 2years, with both outcomes more likely in those with a diagnosis other than HIE. Abnormal MRI findings were found in 45 of the 70 infants imaged. The absence of major cerebral lesions was highly predictive of a normal neurological outcome. We report the first cohort of term infants with seizures fully investigated by MRI. The universal use of MRI enabled a cause to be identified in 95% of cases. The probability of having NDI or recurrence of seizures was extremely low with absence of major cerebral lesions on MRI. This study demonstrates the added value of MRI for diagnosis of aetiology and the prediction of neurological outcome.

Line length as a robust method to detect high-activity events: Automated burst detection in premature EEG recordings

ObjectiveEEG is a valuable tool for evaluation of brain maturation in preterm babies. Preterm EEG constitutes of high voltage burst activities and more suppressed episodes, called interburst intervals (IBIs). Evolution of background characteristics provides information on brain maturation and helps in prediction of neurological outcome. The aim is to develop a method for automated burst detection. MethodsThirteen polysomnography recordings were used, collected at preterm postmenstrual age of 31.4 (26.1–34.4)weeks. We developed a burst detection algorithm based on the feature line length and compared it with manual scorings of clinical experts and other published methods. ResultsThe line length–based algorithm is robust (84.27% accuracy, 84.00% sensitivity, 85.70% specificity). It is not critically dependent on the number of measurement channels, because two channels still provide 82% accuracy. Furthermore, it approximates well clinically relevant features, such as median IBI duration 5.45 (4.00–7.11)s, maximum IBI duration 14.02 (8.73–18.80)s and burst percentage 48.89 (35.45–60.12)%, with a median deviation of respectively 0.65s, 1.96s and 6.55%. ConclusionAutomated assessment of long-term preterm EEG is possible and its use will optimize EEG interpretation in the NICU. SignificanceThis study takes a first step towards fully automatic analysis of the preterm brain.

Continuous Electroencephalogram in Comatose Postcardiac Arrest Syndrome Patients Treated With Therapeutic Hypothermia

Therapeutic Hypothermia (TH) is the only therapeutic intervention proven to significantly improve survival and neurologic outcome in comatose postcardiac arrest patients and is now considered standard of care. When we discuss prognostication with regard to comatose survivors postcardiac arrest, we should look for tools that are both reliable and accurate and that achieve a false-positive rate (FPR) equal to or very closely approaching zero. We retrospectively reviewed data that were prospectively collected on all cardiac arrest patients admitted to our ICU. Continuous electroencephalogram (cEEG) monitoring was performed as part of our protocol for therapeutic hypothermia in comatose postcardiac arrest patients. The primary outcome measure was the best score on hospital discharge on the 5-point Glasgow-Pittsburgh cerebral performance category (CPC) scores. A total of 58 patients were included in this study. Twenty five (43%) patients had a good neurologic outcome (CPC score of 1-2). Three (5.2%) patients had nonconvulsive status epilepticus, all of whom had poor outcome (CPC = 5). Seventeen (29%) patients had burst suppression (BS); all had poor outcome. Both nonconvuslsive seizures (NCS) and BS had a specificity of 100% (95% confidence interval [CI], 84%-100%), positive predictive values of 100% (95% CI, 31%-100%), and 100% (95% CI, 77%-100%), respectively. Both NCS and BS had FPRs of zero (95% CI, 0.0-0.69, and 0.0-0.23, respectively). In comatose postcardiac arrest patients treated with hypothermia, EEG during the maintenance and rewarming phase of hypothermia can contribute to prediction of neurologic outcome. Pending large multicenter prospective studies evaluating the role of cEEG in prognostication, our study adds to the existing evidence that cEEG can play a potential role in prediction of outcome in postcardiac arrest patients treated with hypothermia.

Prognostic Value and Optimal Sampling Time of S-100B Protein for Outcome Prediction in Cardiac Arrest Patients Treated with Therapeutic Hypothermia

Background: The aim of this study was to determine the prognostic value and optimal sampling time of serum S-100B protein for the prediction of poor neurological outcomes in post-cardiac arrest (CA) patients treated with therapeutic hypothermia (TH). Methods: We prospectively measured serum S100 calcium binding protein beta subunit (S-100B protein) levels 12 times (0-96 hours) after the return of spontaneous circulation (ROSC). The patients were classified into two groups based on cerebral performance category (CPC): the good neurological outcome group (CPC 1-2 at 6 months) and the poor neurological outcome group (CPC 3-5). We compared serial changes and serum S-100B protein levels at each time point between the two groups and performed receiver operating characteristic curve analysis for the prediction of poor neurological outcomes. Results: A total of 40 patients were enrolled in the study. S-100B protein levels peaked at ROSC (0 hour), decreased rapidly to 6 hours and maintained a similar level thereafter. Serum S-100B protein levels in the poor CPC group (n = 22) were significantly higher than in the good CPC group (n = 18) at all time points after ROSC except at 4 hours. The time points with highest area under curve were 24 (0.829) and 36 (0.837) hours. The cut-off value, the sensitivity (24/36 hours) and specificity (24/36 hours) for the prediction of poor CPC at 24 and 48 hours were 0.221/0.249 ug/L, 75/65% and 82.4/94.1%, respectively. Conclusions: Serum S-100B protein was an early and useful marker for the prediction of poor neurological outcomes in post-CA patients treated with TH and the optimal sampling times were 24 and 36 hours after ROSC.

LONG TERM NEURODEVELOPMENTAL OUTCOME IN A COHORT OF PRETERM INFANTS BORN AT GESTATIONAL AGE

Advances in perinatal care have led to an increase in survival of preterm children but have also increased the risk of long-term sequelae, like neurodevelopmental impairment and behavioral or emotional disturbance. To investigate neurodevelopmental patterns of preterm infants born at S. Maria alle Scotte Hospital, Siena, Italy. 128 babies with gestational age (GA) ≤32 weeks were admitted in 2006-2008 to Siena Hospital; 105 infants survived and were followed until three years of age, corrected for prematurity. Neurodevelopmental follow up was performed using Bayley scale of Infant and Toddler Development IIIed that consisted of five scales: Cognitive (CS), Language (LS), Motor (MS), Social-Emotional (SES) and Adaptive Behavior Scale (ABS). Intraventricular haemorrhage (IVH) was associated with lower motor score (P<0,001). Babies with retinopathy of prematurity (ROP) showed a lower score in CS, LS, MS and SES Bayley’s items (respectively p≤0,01; p≤0,05; p≤0,01; p≤0,05). Multiple regression analysis indicated as predictors of neurological outcome: gestational age (GA) for poor cognitive (p=0,016), language (p=0,004) and social-emotional development (p<0,0001), IVH for poor motor (p<0,0001) and adaptive behavior development (p<0,0001), twinship for better language (p=0,001) and social-emotional development (p=0,003). Bronchopulmoanry dyspasia (BPD) and patent ductus arteriosus (PDA) had a negative effect on respectively cognitive development (p=0,049) and social-emotional development (p=0,023). ROP, BPD, IVH, PDA, and GA significantly contributes to poor neurological outcome in preterm infants. BPD and IVH are the best predictors being associated with the lowest scores at Bayley scales. Surprisingly, twinship appeared to be a protective factor.

LONG TERM NEURODEVELOPMENTAL OUTCOME IN A COHORT OF PRETERM INFANTS BORN AT GESTATIONAL AGE &lt;32 WEEKS

Advances in perinatal care have led to an increase in survival of preterm children but have also increased the risk of long-term sequelae, like neurodevelopmental impairment and behavioral or emotional disturbance. To investigate neurodevelopmental patterns of preterm infants born at S. Maria alle Scotte Hospital, Siena, Italy. 128 babies with gestational age (GA) ≤32 weeks were admitted in 2006-2008 to Siena Hospital; 105 infants survived and were followed until three years of age, corrected for prematurity. Neurodevelopmental follow up was performed using Bayley scale of Infant and Toddler Development IIIed that consisted of five scales: Cognitive (CS), Language (LS), Motor (MS), Social-Emotional (SES) and Adaptive Behavior Scale (ABS). Intraventricular haemorrhage (IVH) was associated with lower motor score (P&lt;0,001). Babies with retinopathy of prematurity (ROP) showed a lower score in CS, LS, MS and SES Bayley’s items (respectively p≤0,01; p≤0,05; p≤0,01; p≤0,05). Multiple regression analysis indicated as predictors of neurological outcome: gestational age (GA) for poor cognitive (p=0,016), language (p=0,004) and social-emotional development (p&lt;0,0001), IVH for poor motor (p&lt;0,0001) and adaptive behavior development (p&lt;0,0001), twinship for better language (p=0,001) and social-emotional development (p=0,003). Bronchopulmoanry dyspasia (BPD) and patent ductus arteriosus (PDA) had a negative effect on respectively cognitive development (p=0,049) and social-emotional development (p=0,023). ROP, BPD, IVH, PDA, and GA significantly contributes to poor neurological outcome in preterm infants. BPD and IVH are the best predictors being associated with the lowest scores at Bayley scales. Surprisingly, twinship appeared to be a protective factor.

Peri-intraventricular hemorrhage in preterm infants: the importance of screening by transfontanellar ultrasound

Objectives. In preterm babies, peri-intraventricular hemorrhages (PIVH) might cause various degrees of neuropsycho-motor impairment. A 4-year prospective study (2009-2012) performed in the IOMC, was aimed to determine the prevalence of different degrees of PIVH diagnosed by head ultrasound (HUS) among 160 admitted preterm babies, the associated risk factors, along with the neuro-developmental effects on a 12-month follow-up period. Material and methods. In the above-mentioned period all admitted preterms were examined by transfontanelar ultrasound according to a standardized protocol based on Papile’s PIVH classification. For those preterms included in the study a 12-month systematic neurologic follow-up was performed. Results. PIVH grade I (45%) and II (37,5%) were the most prevalent types. Grade IV PIVH represented 4,4% from all PIVH cases. The good neurological outcome of grade I and II PIVH, was found to be statistically significant (p &lt; 0.01) for both types. Severe neurological sequelae were associated with grade III and IV and a statistically significant correlation (p&lt;0.01) was found only for grade IV hemorrhages. Conclusion. Systematic HUS screenings for all preterm babies is useful for early diagnosis and PIVH staging, for neurologic outcome prediction, providing the appropriate management strategy and a well-suited parental counseling.

The prognostic value of plasma Δ-copeptin levels in patients with isolated traumatic brain injury.

Traumatic brain injury (TBI) is one of the most common causes of death among trauma patients. Earlier prediction of possible poor neurological outcomes, even upon admission to the emergency department, may help to guide treatment. The aim of this prospective study was to assess the predictive value of plasma copeptin levels for early morbidity and mortality in patients with isolated TBI. This prospective study comprised 53 patients who were admitted to the emergency department with isolated TBI. Forty-two of these patients (group I) survived at least 1month after the TBI; the other 11 (group II) did not. Plasma levels of copeptin were measured in these TBI patients at admission and 6h after trauma, and were compared with those of healthy volunteers (group III). At admission, the copeptin levels of the TBI patients (groups I and II combined) were not statistically significantly different from those of the control group (III). The copeptin levels 6h after trauma were also not statistically significantly different from those at admission. Δ-Copeptin levels (the difference between the copeptin level at the 6th hour after trauma and that at admission) were higher in the patients who died within a month of the TBI. Further, Δ-copeptin levels were higher in patients who showed no improvement in the modified Rankin score when compared with patients with an improved modified Rankin score. The best cutoff point for Δ-copeptin was 0.51ng/ml for predicting mortality and 0.23ng/ml for predicting improvement in the modified Rankin score. Plasma Δ-copeptin levels may help physicians predict the prognoses of patients suffering from traumatic brain injury.

Abstract 99: Estimated Regional Oxy-hemoglobin Concentration is an Excellent and Simple Predictor of Neurological Outcome for Post Cardiac Arrest Syndrome: A Prospective Multicenter Observational Study

Background: We previously reported that an regional cerebral oxygen saturation (rSO2) at hospital arrival can predict neurological outcomes in patients who suffered out-of-hospital cardiac arrest. In this post-hoc analyses, we investigated whether estimated regional oxy-Hb (erHbO2), the product of Hb and rSO2 which might represent regional tissue oxy-Hb existence theoretically, plays pivotal role in the development of neurological impairment in patients with post cardiac arrest patients (PCAS). Methods &amp; Results: From May 2011 through July 2012, 363 consecutive comatose survivors admitted to hospitals were analyzed in this study. The primary outcome measure was a neurological outcome at 90 days. Forty-five patients (12.4%) presented good neurological outcome. The receiver operating characteristic curve analyses revealed rSO2 cutoff of 40% and erHbO2 cutoff of 3.6 had the maximum joint sensitivity and specificity to predict a good neurological outcome (rSO2: AUCs, 0.831; 95%CI, 0.770-0.892; sensitivity, 84.4%; specificity, 76.1%. erHbO2: AUCs, 0.872; 95%CI, 0.821-0.923; sensitivity, 91.1%; specificity, 71.4%). In a subgroup of patients with rSO2 &gt;40% of optimal cutoff (n=114, 38 [33.3%] patients with good outcome), multivariate analysis revealed that erHbO2 was a significant predictor of a good neurological outcome (Odds: 1.34, 95% CI; 1.04-1.71, p=0.02), such that a 1-point increase in erHbO2 is associated with approximately 35% increase in the odds for good neurological outcome. Conclusion: Our results demonstrate that rSO2 and erHbO2 can predict good neurological outcome. erHbO2 may be a useful index for neuro-protection in patients with PCAS.

Abstract 182: Medical Comorbidities and Age Both Predict Neurological Outcomes in Survivors of Cardiac Arrest Treated With Hypothermia

Introduction: Age is a known predictor of outcome in comatose survivors of out of hospital cardiac arrest (OHCA), but it is unknown whether this is inherent or because age is a marker for overall health status. In a cohort treated with hypothermia, we hypothesized that age and pre-arrest comorbidities would both contain unique neurological prognostic information. Methods: We conducted a retrospective cohort study, reviewing electronic medical records of all patients treated with mild therapeutic hypothermia (MTH) in the University of Michigan Emergency Department for OHCA. We categorized patients’ past medical history into a Charlson Comorbidity Index (CCI). Age was analyzed by decade. Neurologic outcomes were determined 6-12 months post-discharge by Cerebral Performance Category (CPC). Logistic models were evaluated by c-statistics and likelihood ratio tests. Trends were evaluated using one-sided Cochrane Armitage tests. Results: After exclusions, 123 patients received MTH between 7/1/2006 and 9/14/2012. Favorable neurological outcomes in patients with CCI 0, 1-2, 3-4, and ≥5 are shown (figure). Odds ratio (95% confidence intervals) by CCI category were 1 (ref), 0.4 (0.1-1.0), 0.5 (0.2-1.7), and 0.2 (0.03-0.9) (c = 0.65, p for trend=0.04). Combined Charlson-age index had slightly higher predictive ability (c=0.71, p=0.0004). CCI added significant predictive ability when added onto a model containing only age (c-statistic increased from 0.71 to 0.78; likelihood ratios p=0.0073). Similarly, age added significant predictive ability when added onto a model containing CCI alone (c-statistic increased from 0.65 to 0.78; p=0.0001) Conclusions: Both age and pre-arrest comorbidities are associated with outcome in comatose survivors of cardiac arrest, but the former appears to be a stronger predictor. This may reflect limitations of the health index used, but more likely that age is an independent predictor of prognosis rather than a marker for comorbidity.

Cerebral Regional Oxygen Saturation and Serum Neuromarkers for the Prediction of Adverse Neurologic Outcome in Pediatric Cardiac Surgery

The aim of this study is to determine the utility of non-invasive bedside neuromonitoring, including cerebral regional oxygen saturation (rSO2) measured by near-infrared spectroscopy and serum biomarkers, in identifying children at risk from adverse neurological outcome after heart surgery. Prospective observational study including 39 consecutive children undergoing heart surgery with cardiopulmonary bypass (CPB) and normal neurologic exam prior to surgery. Cerebral rSO2 was measured at baseline (prior to surgery) and then continuously during surgery and for the first 16 h post-operatively. Neuromarkers [neuron-specific enolase (NSE), S100β, glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF)] were measured in serum at baseline, immediately after CPB and at 16 h post-operatively. Adverse neurological outcome was defined as an abnormal pediatric cerebral performance category (PCPC) scale score at 12 months after surgery. Sixteen children (41 %) had an abnormal PCPC scale score at the 12-month evaluation after surgery. In children with unfavorable neurological outcomes, mean cerebral rSO2 values were lower and the area-under-the-curve below a threshold of 40 and 20% below baseline were also increased. No significant differences were found in serum neuromarkers between groups at the time points that were assessed. Bedside determination of cerebral rSO2 may have some utility in identifying children at risk for adverse neurological outcome after heart surgery in children. Additional studies that are sufficiently powered to control for the many covariates in this patient population will be required to fully interrogate this important question. The role of serum neuromarkers in the immediate post-operative period do not appear to be helpful in this question, though more thorough interrogation of delayed periods may ultimately demonstrate some utility in answering this question.

Clinical Predictors of Neurologic Outcome in Cardiac Arrest Patients Post Induced Hypothermia

Clinical Predictors of Neurologic Outcome in Cardiac Arrest Patients Post Induced Hypothermia

Factors Related to the Initial Stroke Severity of Posterior Circulation Ischemic Stroke

Background: Posterior circulation (PC) stroke, which was previously less well known than anterior circulation (AC) stroke, has become more identified due to the development of imaging equipment. Recently, the initial stroke severity assessed by the NIH Stroke Scale (NIHSS) was reported as a useful measure for predicting the outcome of PC as well as AC stroke. The aim of our study was to investigate the factors related to the stroke severity of PC ischemic stroke as assessed by the baseline NIHSS and the predictors of progressive neurological deficit and 3-month outcome. Methods: All patients with first-time PC stroke (onset ≤7 days), admitted for a 5-year period and given a complete evaluation including brain MRI and angiographic studies, were enrolled. Patients were divided into two groups by the baseline NIHSS: moderate-to-severe stroke (MTSS, NIHSS >5) and mild stroke (MS, NIHSS ≤5). Baseline characteristics, symptoms and progression, etiological subtypes, lesion characteristics from imaging, and patient 3-month outcome assessed by the modified Rankin Scale (mRS) were compared between the two groups. Results: Among 604 enrolled patients with PC ischemic stroke, 143 belonged to the MTSS group and 461 to the MS group. In logistic regression analysis, MTSS was independently associated with white blood cell count (odds ratio, OR = 1.00, p = 0.001), high sensitivity C-reactive protein level (OR = 1.23, p = 0.004), dysarthria (OR = 2.59, p = 0.013), weakness (OR = 6.43, p < 0.001), dysphagia (OR = 5.77, p < 0.001) and decreased consciousness (OR = 10.54, p < 0.001). The independent predictors associated with progressive neurological deficit were MTSS (OR = 3.82, p = 0.001), the distal territory classified by lesion location (OR = 0.09, p = 0.004) and dysphagia (OR = 2.38, p = 0.010). The independent predictors associated with a 3-month mRS of 3-6 were MTSS (OR = 7.69, p < 0.001), diplopia (OR = 0.26, p = 0.023), visual field defect (OR = 4.87, p = 0.014), dysphagia (OR = 3.15, p < 0.001) and progressive neurological deficit (OR = 4.27, p < 0.001). Conclusions: The initial severity categorization of PC ischemic stroke by the NIHSS has provided several distinctions and could help with the prediction of neurological deficit progression and 3-month clinical outcome.

Normalization of similarity-based individual brain networks from gray matter MRI and its association with neurodevelopment in infants with intrauterine growth restriction

Obtaining individual biomarkers for the prediction of altered neurological outcome is a challenge of modern medicine and neuroscience. Connectomics based on magnetic resonance imaging (MRI) stands as a good candidate to exhaustively extract information from MRI by integrating the information obtained in a few network features that can be used as individual biomarkers of neurological outcome. However, this approach typically requires the use of diffusion and/or functional MRI to extract individual brain networks, which require high acquisition times and present an extreme sensitivity to motion artifacts, critical problems when scanning fetuses and infants. Extraction of individual networks based on morphological similarity from gray matter is a new approach that benefits from the power of graph theory analysis to describe gray matter morphology as a large-scale morphological network from a typical clinical anatomic acquisition such as T1-weighted MRI. In the present paper we propose a methodology to normalize these large-scale morphological networks to a brain network with standardized size based on a parcellation scheme. The proposed methodology was applied to reconstruct individual brain networks of 63 one-year-old infants, 41 infants with intrauterine growth restriction (IUGR) and 22 controls, showing altered network features in the IUGR group, and their association with neurodevelopmental outcome at two years of age by means of ordinal regression analysis of the network features obtained with Bayley Scale for Infant and Toddler Development, third edition. Although it must be more widely assessed, this methodology stands as a good candidate for the development of biomarkers for altered neurodevelopment in the pediatric population.

Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest

To determine neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA) and treatment with mild therapeutic hypothermia (MTH). Seventy-three consecutive OHCA patients treated with MTH were retrospectively analyzed. Serum neuron-specific enolase (NSE) was measured 24, 48, and 72 h after admission. In patients with no motor response 48 h after termination of analgosedation (n = 40), clinical neurological examination and evoked potentials (EPs) were determined. Neurological outcome was assessed after 2 months based on the cerebral performance categories (CPC), and categorized as good (CPC 1-3) or poor (CPC 4 and 5). Forty-three patients had a CPC score of 1-3 and 30 patients had a CPC 4-5. The best predictive value for poor neurologic outcome was an increase of NSE by ≥4.3 ng/mL between day 1 and day 2 (sensitivity 80 %, specificity 100 %, positive predictive value (PPV) 100 %, negative predictive value 86 %). Absolute NSE values were less reliable in the prediction of poor outcome with the highest sensitivity (88 %) and specificity (95 %) if values reached ≥36.3 ng/mL on day 3. Somatosensory EPs (SSEPs) showed a specificity of 100 % and PPV of 100 %; however, sensitivity for evoked potentials was low (29 %). Intriguingly, two initially comatose patients with excessive NSE values (24 h NSE: 101 and 256 ng/mL, and 48 h NSE: 93 and 110 ng/mL, respectively) had physiological SSEPs and regained a CPC score of 1. In patients treated with MTH after OHCA changes in NSE are more suitable than its absolute serum levels for the prediction of poor neurologic outcome. Since unequivocal prediction of poor neurologic outcome is of utmost importance in these patients the decision to limit therapy must be based on several prediction tools with the highest PPV and specificity including SSEPs.

O-006 Advanced Age Remains a Strong Independent Predictor of Neurologic Outcome Despite Core Infarct Imaging for Patient Selection

Body Age is a consistent independent predictor of outcome in ischaemic stroke trials. From January 2011 until December of 2012, 85 patients at our institution underwent ischaemic stroke intervention in...

Predictive value of the amplitude integrated EEG in infants with hypoxic ischaemic encephalopathy: data from a randomised trial of therapeutic hypothermia

The amplitude integrated EEG (aEEG) is reputed to be one of the best predictors of neurological outcome following hypoxic ischaemic encephalopathy in term newborns and was used to select infants...