Pain pupillary index to prognosticate unfavorable outcome in comatose cardiac arrest patients.
Brain injury
Heart arrest
Prognostication
Pupillometry
Journal
Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
26
03
2022
revised:
25
04
2022
accepted:
26
04
2022
pubmed:
4
5
2022
medline:
29
6
2022
entrez:
3
5
2022
Statut:
ppublish
Résumé
The prognostic role of the Pupillary Pain Index (PPI), derived from automated pupillometry, remains unknown in post-anoxic brain injury. Single-center retrospective study in adult comatose cardiac arrest (CA) patients. Quantitative PPI and Neurologic Pupil Index (NPi) were concomitantly recorded on day 1 and day 2 after CA. The primary outcome was to assess the prognostic value of PPI to predict 3-month unfavourable outcome (UO, defined as Cerebral Performance Category of 3-5). Secondary outcome was the agreement between PPI and NPi to predict unfavourable outcome. A total of 102 patients were included; patients with UO (n = 69, 68%) showed a lower NPi (4.2 [3.5-4.5] vs. 4.6 [4.3-4.7]; p < 0.01 on day 1-4.3 [3.8-4.7] vs 4.6 [4.3-4.8] on day 2), and PPI (3 [1-6] vs. 6 [3-7]; p < 0.01 on day 1-3 [1-6] vs 6 [4-8]; p < 0.01 on day 2) than others. A PPI = 1 on day 2 showed a sensitivity of 26 [95% CI 16-38]% and a specificity of 100 [95% CI 89-100]% to predict UO (p = 0.003 vs. NPi ≤ 2). On day 2, a total of 6 patients had concomitant PPI = 1 and NPi ≤ 2, while 12 showed NPi > 2 and PPI = 1; the coefficient of agreement was 0.42. Moreover, NPi and PPI values showed a moderate correlation both on day 1 and day 2. In this study, PPI = 1 on day 2 could predict UO in comatose CA patients with 100% specificity, but with a low sensitivity (yet higher than NPi). The agreement between PPI and NPi values was moderate.
Sections du résumé
BACKGROUND
The prognostic role of the Pupillary Pain Index (PPI), derived from automated pupillometry, remains unknown in post-anoxic brain injury.
METHODS
Single-center retrospective study in adult comatose cardiac arrest (CA) patients. Quantitative PPI and Neurologic Pupil Index (NPi) were concomitantly recorded on day 1 and day 2 after CA. The primary outcome was to assess the prognostic value of PPI to predict 3-month unfavourable outcome (UO, defined as Cerebral Performance Category of 3-5). Secondary outcome was the agreement between PPI and NPi to predict unfavourable outcome.
RESULTS
A total of 102 patients were included; patients with UO (n = 69, 68%) showed a lower NPi (4.2 [3.5-4.5] vs. 4.6 [4.3-4.7]; p < 0.01 on day 1-4.3 [3.8-4.7] vs 4.6 [4.3-4.8] on day 2), and PPI (3 [1-6] vs. 6 [3-7]; p < 0.01 on day 1-3 [1-6] vs 6 [4-8]; p < 0.01 on day 2) than others. A PPI = 1 on day 2 showed a sensitivity of 26 [95% CI 16-38]% and a specificity of 100 [95% CI 89-100]% to predict UO (p = 0.003 vs. NPi ≤ 2). On day 2, a total of 6 patients had concomitant PPI = 1 and NPi ≤ 2, while 12 showed NPi > 2 and PPI = 1; the coefficient of agreement was 0.42. Moreover, NPi and PPI values showed a moderate correlation both on day 1 and day 2.
CONCLUSIONS
In this study, PPI = 1 on day 2 could predict UO in comatose CA patients with 100% specificity, but with a low sensitivity (yet higher than NPi). The agreement between PPI and NPi values was moderate.
Identifiants
pubmed: 35504344
pii: S0300-9572(22)00144-7
doi: 10.1016/j.resuscitation.2022.04.026
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
125-131Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [FST is scientific advisor for NeurOptics inc. Other authors have no conflict of interest to declare.]