title: Prediction of short-term and long-term outcomes after cardiac arrest: a prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations.
abstract: OBJECTIVE
  To determine the prognostic accuracy of biochemical, clinical, electrophysiological, and neuropsychological investigations in predicting outcomes after cardiac arrest.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Intensive care unit of the Hamburg-Eppendorf University Medical Center, Hamburg, Germany.
  
  
  METHODS
  A total of 80 patients (mean age, 63.79 +/- 15.85 yrs) after cardiopulmonary resuscitation.
  
  
  METHODS
  Serial blood samples (days 2-4), clinical examinations (days 2 and 4), sensory-evoked potentials (day 4), and neuropsychological assessments (<or=1 and 6 months).
  
  
  RESULTS
  We conducted a prospective study into the combined predictive efficacy of serum concentrations of neuron-specific enolase and protein S-100B, standardized clinical examinations, and short- and long-latency sensory-evoked potentials. For the prognostic validation, both the dichotomized 5-point Glasgow-Pittsburgh Cerebral Performance Categories (1-3, favorable outcome; 4-5, unfavorable outcome) and a comprehensive neuropsychological test battery were applied. A multivariate logistic-regression analysis resulted in a model in which 85% of the variance in the dichotomized Glasgow-Pittsburgh Cerebral Performance Categories was explained by neuron-specific enolase at day 4, clinical examination score at day 4, and age. This predictor index had a sensitivity of 92% and a specificity of 93%. In addition, 26 patients (out of 33) underwent neuropsychological testing at 6 months. Significant correlations were found with selected cognitive variables and S-100B at day 3, long-latency sensory-evoked potential at day 4, and neuropsychological bedside screening.
  
  
  CONCLUSIONS
  A multivariate assessment approach should be used to establish an early high-certainty prognosis after cardiac arrest. However, further prospective clinical studies are necessary to confirm this derived predictor index. In addition, an early recording of S-100B, long-latency sensory-evoked potential, and neuropsychological bedside screening reflect a cognitive long-term outcome.
authors.affiliation: Department of Biological Psychology and Neuropsychology, University of Hamburg, Germany. Joern.Prohl@t-online.de
authors.forename: Jörn
authors.initials: J
authors.lastname: Prohl
authors.forename: Joachim
authors.initials: J
authors.lastname: Röther
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
authors.forename: Geraldine
authors.initials: G
authors.lastname: de Heer
authors.forename: Joachim
authors.initials: J
authors.lastname: Liepert
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bodenburg
authors.forename: Kurt
authors.initials: K
authors.lastname: Pawlik
authors.forename: Georg
authors.initials: G
authors.lastname: Kreymann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation; D003128:Coma; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009414:Nerve Growth Factors / Q000097:blood*; D009483:Neuropsychological Tests; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase