title: Immature/total granulocyte ratio improves early prediction of neurological outcome after out-of-hospital cardiac arrest: the MyeloScore study.
abstract: BACKGROUND
  Elevation of the immature/total granulocyte (I/T-G) ratio has been reported after out-of-hospital cardiac arrest (OHCA). Our purpose here was to evaluate the prognostic significance of the I/T-G ratio and to investigate whether the I/T-G ratio improves neurological outcome prediction after OHCA.
  
  
  METHODS
  This single-center prospective cohort study included consecutive immunocompetent patients admitted to our intensive care unit over a 3-year period (2012-2014) after successfully resuscitated OHCA. The I/T-G ratio was determined in blood samples collected at admission.
  
  
  RESULTS
  We studied 204 patients (77 % male, median age, 58 [48-67] years), of whom 64 % had a suspected cardiac cause of OHCA, 62 % died in the unit, and 31.5 % survived with good cerebral function. Independent outcome predictors by multivariate analysis were age, first shockable rhythm, bystander-initiated resuscitation, and I/T-G ratio. Compared to the model computed without the I/T-G ratio, the model with the ratio performed significantly better [areas under the ROC curves (AUCs), 0.78 vs. 0.83, respectively; P = 0.04]. These items were used to develop the MyeloScore equation: ([0.47 × I/T-G ratio] + [0.023 × age in years]) - 1.26 if initial VF/VT - 1.1 if bystander-initiated CPR. The MyeloScore predicted neurological outcomes with similar accuracy to the previously reported OHCA score (0.83 and 0.85, respectively; P = 0.6). The ROC-AUC was 0.84, providing external validation of the MyeloScore.
  
  
  CONCLUSIONS
  The I/T-G ratio independently predicts neurological outcome after OHCA and, when added to other known risk factors, improves neurological outcome prediction. The clinical performance of the MyeloScore requires evaluation in a prospective study.
authors.affiliation: Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-Octeville, France. b.sauneuf@ch-cotentin.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sauneuf
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.|Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bouffard
authors.affiliation: Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.|Faculté de Médecine, EA 4652 - MILPAT, Université de Caen Basse-Normandie, 14033, Caen, France.|Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Cornet
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.
authors.forename: Cedric
authors.initials: C
authors.lastname: Daubin
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.|Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brunet
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Seguin
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Valette
authors.affiliation: Service d'Hématologie Biologique, Hôpital Cochin, AP-HP, Paris, France.|Institut Cochin, CNRS (UMR8104), INSERM, U1016, Université Paris Descartes, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chapuis
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.|Faculté de Médecine, EA 4655 U2RM, Université de Caen Basse-Normandie, 14032, Caen, France.|Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
authors.affiliation: Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.|Faculté de Médecine, EA 4655 U2RM, Université de Caen Basse-Normandie, 14032, Caen, France.|Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.|Inserm U 1075 COMETE, 14032, Caen, France.|Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.|HP2, Inserm U1042, Université Grenoble-Alpes, 38000, Grenoble, France.|Service de réanimation médicale, CHU Grenoble Alpes, 38000, Grenoble, France.|Faculté de Médecine, Université Grenoble-Alpes, 38000, Grenoble, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terzi
keywords: Biological markers; Disability; Out-of-hospital cardiac arrest; Prognosis; Survival