Is gray-white matter ratio in out-of-hospital cardiac arrest patients' really early predictor of neurological outcome?

Objective: This study aimed to evaluate the association between neurological outcome and gray-white ratio (GWR) in brain computed tomography (CT) in patients with return of spontaneous circulation (ROSC) who were brought to the emergency department (ED) due to out-of-hospital cardiac arrest (OHCA).

Methods: This study has a retrospective design. Patients with ROSC who were brought to the ED due to OHCA and who underwent brain CT in the first 24 h were included in the study. Demographic data, brain CT results (intensities of gray matter and white matter in Hounsfield units and calculated GWR), and hospital outcome were recorded. The cerebral Performance Categories (CPC) score was used as the outcome of the study.

Results: A total of 160 patients were included in the study. 55% of the patients were male and the median age was 75.5. The median brain CT time of the patients was 120 min. 16.3% of the patients were in the good neurological outcome group. When attenuation values and GWRs of the patients were compared according to CPC of patients (good-poor), no statistically significant difference was detected in any parameter except MC2 attenuation (P > 0.05 for all values). The patients were separated into groups geriatric and nongeriatric and GWRs were compared. GWRs were lower in the geriatric groups (P < 0.05 for all values).

Conclusion: Although it is emphasized in the literature that detection of low GWR in brain CT can help the clinical decision process in patients surviving comatose arrest, we think that it is not valid for especially in geriatric patients and in patients who underwent early brain CT after ROSC.