• Sidonio J da Silva Pereira, Dong Hoon Lee, Jung Soo Park, Changshin Kang, Byung Kook Lee, In Sool Yoo, In Ho Lee, Mijoo Kim, and Jae Gwang Lee.
• Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea; Emergency Department of Guido Valadares National Hospital, Avenida Dom. Martino Lopes, Culu Hun, Cristo Rey, Dili, Timor-Leste.
• J Emerg Med. 2024 Aug 1; 67 (2): e177e187e177-e187.

BackgroundHypoxic-ischemic brain injury (HIBI) is a common complication of out-of-hospital cardiac arrest (OHCA).ObjectivesWe investigated whether grey-to-white matter ratio (GWR) values, measured using early head computed tomography (HCT), were associated with neurologic outcomes based on the severity of HIBI in survivors of OHCA.MethodsThis retrospective multicenter study included adult comatose OHCA survivors who underwent an HCT scan within 2 h after the return of spontaneous circulation. HIBI severity was assessed using the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) scale (low, moderate, and severe). Poor neurologic outcomes were defined as Cerebral Performance Categories 3 to 5 at 6 months after OHCA.ResultsAmong 354 patients, 27% were women and 224 (63.3%) had poor neurologic outcomes. The distribution of severity was 19.5% low, 47.5% moderate, and 33.1% severe. The area under the receiver operating curves of the GWR values for predicting rCAST severity (low, moderate, and severe) were 0.52, 0.62, and 0.79, respectively. The severe group had significantly higher predictive performance than the moderate group (p = 0.02). Multivariate logistic regression analysis revealed a significant association between GWR values and poor neurologic outcomes in the moderate group (adjusted odds ratio = 0.012, 95% CI 0.0-0.54, p = 0.02).ConclusionsIn this cohort study, GWR values measured using early HCT demonstrated variations in predicting neurologic outcomes based on HIBI severity. Furthermore, GWR in the moderate group was associated with poor neurologic outcomes.Copyright © 2024 Elsevier Inc. All rights reserved.

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