Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study.
Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study.
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DOI：
10.1007/s00134-018-5448-6
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发表时间：
2018-12
影响因子：
38.9
通讯作者：
Taccone FS
中科院分区：
文献类型：
--
作者：
Oddo M;Sandroni C;Citerio G;Miroz JP;Horn J;Rundgren M;Cariou A;Payen JF;Storm C;Stammet P;Taccone FS
评估定量瞳孔测量法[使用神经性瞳孔指数(NPI)]预测心脏骤停(CA)后不良神经结局的能力。我们对成年昏迷的CA患者进行了一项前瞻性的国际多中心研究(10个中心)。从CA后第1天到第3天，并行记录定量NPI和标准手动瞳孔光反射(SPLR)-对临床医生和结果评估员来说是盲目的。主要研究终点是比较NPI和sPLR在预测3个月脑功能类别(CPC)方面的价值，将其分为有利(CPC 1-2：完全恢复或中度残疾)和不良结局(CPC 3-5：重度残疾、植物状态或死亡)。在第1天至第3天之间的任何时间， ≤ 2(n = 456例患者)的阴性预测值和阳性预测值分别为51%(95%CI 49-53)和100%[PPV；0%(0-2)假阳性率]，预测不良结局的特异性为100%(98-100)，敏感性为32%(27-38)。与NPI相比，SLR的PPV值和特异度显著降低(p 和 在第1天和第2天为0.001；p- = 在第3天为0.06)。NPI ≤ 2联合双侧缺失体感诱发电位(n = 188例)具有较高的敏感性[58%(49~67)vs 48%(39~57)]，具有相似的特异性[100%(94~100)]。定量NPI对CA术后第1天的不良结果有很好的预测能力，没有假阳性，比标准的人工瞳孔检查有显著更高的特异性。在SSEP中加入NPI提高了结果预测的敏感性，同时保持了100%的特异性。本文的在线版本(10.1007/s001340185448-6)包含补充材料，授权用户可以使用。
To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA). We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death). At any time between day 1 and 3, an NPi ≤ 2 (n = 456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p < 0.001 at day 1 and 2; p = 0.06 at day 3). The combination of NPi ≤ 2 with bilaterally absent somatosensory evoked potentials (SSEP; n = 188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)]. Quantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity. The online version of this article (10.1007/s00134-018-5448-6) contains supplementary material, which is available to authorized users.
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影响因子：
6.5
作者：
Dragancea, Irina;Horn, Janneke;Cronberg, Tobias
通讯作者：
Cronberg, Tobias
影响因子：
158.5
作者：
Nielsen, Niklas;Wettersley, Jorn;Friberg, Hans
通讯作者：
Friberg, Hans
Stard 2015：用于报告诊断准确性研究的基本项目的更新列表。
DOI：
10.1136/bmj.h5527
发表时间：
2015-10-28
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Bossuyt PM;Reitsma JB;Bruns DE;Gatsonis CA;Glasziou PP;Irwig L;Lijmer JG;Moher D;Rennie D;de Vet HC;Kressel HY;Rifai N;Golub RM;Altman DG;Hooft L;Korevaar DA;Cohen JF;STARD Group
通讯作者：
STARD Group
影响因子：
6.5
作者：
Heimburger, Delphine;Durand, Michel;Payen, Jean-Francois
通讯作者：
Payen, Jean-Francois
影响因子：
4.6
作者：
Shoyombo, Ifeoluwa;Aiyagari, Venkatesh;Olson, DaiWai M.
通讯作者：
Olson, DaiWai M.