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Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients : an international prospective multicenter double-blinded study

Oddo, Mauro ; Sandroni, Claudio ; Citerio, Giuseppe ; Miroz, John Paul ; Horn, Janneke ; Rundgren, Malin LU ; Cariou, Alain ; Payen, Jean François ; Storm, Christian and Stammet, Pascal , et al. (2018) In Intensive Care Medicine 44(12). p.2102-2111
Abstract

Purpose: To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA). Methods: 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). Results: At... (More)

Purpose: To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA). Methods: 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). Results: 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)]. Conclusions: 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.

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publication status
published
subject
keywords
Cardiac arrest, Neurological pupil index, Outcome, Prognostication, Pupillary reactivity, Pupillometry
in
Intensive Care Medicine
volume
44
issue
12
pages
10 pages
publisher
Springer
external identifiers
  • pmid:30478620
  • scopus:85057524057
ISSN
0342-4642
DOI
10.1007/s00134-018-5448-6
language
English
LU publication?
yes
id
4d470868-2614-4b2f-83dc-a3d2df1eb38e
date added to LUP
2018-12-21 09:43:56
date last changed
2020-07-08 04:36:52
@article{4d470868-2614-4b2f-83dc-a3d2df1eb38e,
  abstract     = {<p>Purpose: To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA). Methods: 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). Results: 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 &lt; 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)]. Conclusions: 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.</p>},
  author       = {Oddo, Mauro and Sandroni, Claudio and Citerio, Giuseppe and Miroz, John Paul and Horn, Janneke and Rundgren, Malin and Cariou, Alain and Payen, Jean François and Storm, Christian and Stammet, Pascal and Taccone, Fabio Silvio},
  issn         = {0342-4642},
  language     = {eng},
  number       = {12},
  pages        = {2102--2111},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients : an international prospective multicenter double-blinded study},
  url          = {http://dx.doi.org/10.1007/s00134-018-5448-6},
  doi          = {10.1007/s00134-018-5448-6},
  volume       = {44},
  year         = {2018},
}