Prognostic value of computed tomography score in patients after extracorporeal cardiopulmonary resuscitation

Background: We evaluated whether Alberta Stroke Program Early Computed Tomography Score (ASPECTS) with some modifications could be used to predict neurological outcomes in patients after extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This was a retrospective, multicenter, and observational study of adult unconscious patients who were evaluated by brain CT scan within 48 hours after ECPR between May 2010 and December 2016. ASPECTS, bilateral ASPECTS (ASPECTS-b), and modified ASPECTS (mASPECTS) were assessed by receiver operating characteristic curves to predict neurological outcomes. The primary outcome was neurological status upon hospital discharge assessed with Cerebral Performance Categories (CPC) scale. Results: Among 84 unconscious patients, survival to discharge was identified in 25 (29.8%) patients. Of these 25 survivors, 19 (22.6%) had good neurological outcomes (CPC score of 1 or 2). Inter-rater reliabilities of CT scores were excellent. Intraclass correlation coefficients of ASPECTS, ASPECTS-b, and mASPECTS were 0.927 (95% confidence interval [CI]: 0.889 to 0.952), 0.928 (95% CI: 0.891 – 0.953), and 0.928 (95% CI: 0.892 – 0.953), respectively. The predictive performance of mASPECTS for poor neurological outcome was better than that of ASPECTS or ASPECTS-b (C-statistic for mASPECTS vs. ASPECTS: 0.874 vs. 0.778, p = 0.008; mASPECTS vs. ASPECTS-b: 0.874 vs. 0.803, p = 0.011). On multivariable analysis, mASPECTS was an independent predictor for poor neurologic outcomes after ECPR (adjusted odds ratio: 0.78, 95% CI: 0.629 – 0.960). Conclusions: Modified ASPECTS might be useful for predicting neurological outcomes in patients after ECPR.研究背景：本研究旨在评估经改良的阿尔伯塔卒中项目早期CT评分（Alberta Stroke Program Early Computed Tomography Score, ASPECTS）是否可用于预测体外心肺复苏（extracorporeal cardiopulmonary resuscitation, ECPR）后患者的神经功能预后。 研究方法：本研究为一项回顾性多中心观察性研究，纳入2010年5月至2016年12月期间在ECPR术后48小时内接受颅脑CT扫描的成年昏迷患者。采用受试者工作特征曲线评估ASPECTS、双侧ASPECTS（ASPECTS-b）及改良ASPECTS（modified ASPECTS, mASPECTS）对神经功能预后的预测价值。本研究的主要结局为出院时的神经功能状态，采用脑性能分类（Cerebral Performance Categories, CPC）量表进行评估。 研究结果：本研究共纳入84例昏迷患者，其中25例（29.8%）患者存活至出院。在上述25例存活患者中，19例（22.6%）具备良好神经功能预后（CPC评分1或2分）。各CT评分的观察者间一致性极佳：ASPECTS、ASPECTS-b及mASPECTS的组内相关系数分别为0.927（95%置信区间[CI]：0.889~0.952）、0.928（95%CI：0.891~0.953）及0.928（95%CI：0.892~0.953）。mASPECTS对不良神经功能预后的预测性能优于ASPECTS或ASPECTS-b（mASPECTS与ASPECTS的C统计量分别为0.874与0.778，p=0.008；mASPECTS与ASPECTS-b的C统计量分别为0.874与0.803，p=0.011）。多变量分析显示，mASPECTS是ECPR术后不良神经功能预后的独立预测因素（校正比值比：0.78，95%CI：0.629~0.960）。 研究结论：改良ASPECTS或许可用于预测ECPR术后患者的神经功能预后。