The following is a summary of “Development of prognostic models for predicting 90-day neurological function and mortality after cardiac arrest,” published in the May 2024 issue of Emergency Medicine by Ding, et al.

Survivors of cardiac arrest often experience varying degrees of hypoxic-ischemic brain injury, leading to mortality and long-term neurological disability. However, there remained a need for robust prognostic models to predict these outcomes accurately. For a study, researchers sought to establish reliable models for predicting 90-day neurological function and mortality in adult patients in ICU recovering from cardiac arrest.

Patients recovering from cardiac arrest at Binhaiwan Central Hospital of Dongguan were enrolled between January 2018 and July 2021. The primary outcome was 90-day neurological function, categorized as good (Cerebral Performance Category (CPC) 1–2) or poor (CPC 3–5). The secondary outcome was 90-day mortality. Four models were developed: two logistic regression models (models 1 and 2) for predicting neurological function and two Cox regression models (models 3 and 4) for predicting mortality. Models 2 and 4 included new neurological biomarkers as predictor variables, while models 1 and 3 did not. Calibration, discrimination, clinical utility, and relative performance were evaluated to establish superiority among the models.

Model 1 included gender, site of cardiopulmonary resuscitation (CPR), total CPR time, and acute physiology and chronic health evaluation II (APACHE II) score, while model 2 incorporated these variables plus serum level of ubiquitin carboxy-terminal hydrolase L1 (UCH-L1). Model 2 showed superior performance with an area under the receiver operating characteristic curve (AUC) of 0.97 compared to 0.83 for model 1. Similarly, models 3 and 4, designed to predict 90-day mortality, showed that model 4 outperformed model 3 with an AUC of 0.926 and a C-index of 0.830. Clinical decision curve analysis confirmed the net benefit of model 4.

The integration of new neurological biomarkers has led to the development of enhanced models that can more accurately predict 90-day neurological function and mortality outcomes.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000809