Evidence map›Paper›PMID 39592066›Full record

ArticleResuscitation2025

Time-dependent association of grey-white ratio on early brain CT predicting outcomes after cardiac arrest at hospital discharge.

Nicholas Case, Patrick J Coppler, Joseph Mettenburg, Cecelia Ratay, Jonathan Tam, Laura Faiver, Clifton Callaway, Jonathan Elmer, University of Pittsburgh Post-Cardiac Arrest Service

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Resuscitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Review
  3. Review
  4. [Neurological prognosis after cardiac arrest and resuscitation].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026
    Review
  5. Article
  6. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Nicholas CaseDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics and Health Data Science, University of Pittsburgh, Pittsburgh, PA, USA.
Patrick J CopplerDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Joseph MettenburgDepartment of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
Cecelia RatayDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Jonathan TamDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Laura FaiverDepartment of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Clifton CallawayDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Jonathan ElmerDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: elmerjp@upmc.edu.
University of Pittsburgh Post-Cardiac Arrest Service

Funding

NRSA Training CoreTL1TR001858 · NCATS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI RADOMSKI, THOMAS, RUBIO, DORIS M · 2016 to 2025
$11.1M
PREcision Care In Cardiac ArrEst - ICECAP (PRECICECAP)R01NS119825 · NINDS · STANFORD UNIVERSITY · PI ELMER, JONATHAN, HIRSCH, KAREN G · 2021 to 2025
$7.0M
Strategies to Innovate EmeRgENcy Care Clinical Trials Network (SIREN) - Clinical Coordinating Center (CCC)U24NS100659 · NINDS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI WILLIAM G BARSAN, Clifton W. Callaway · 2017 to 2026
$6.4M
Multidisciplinary Training in Critical Care Outcomes ResearchT32HL007820 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI Timothy D Girard, Jeremy M Kahn · 1996 to 2026
$6.4M
Optimizing Recovery prediction after Cardiac Arrest (ORCA)R01NS124642 · NINDS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI Jonathan Elmer · 2022 to 2026
$3.2M
Strategies to Innovate EmeRgENcy Care Clinical Trials Network (SIREN) - PittsburghU24NS100656 · NINDS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI Clifton W. Callaway · 2017 to 2026
$2.4M
Emergency Medicine Research TrainingT32HL134615 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI Clifton W. Callaway, DONALD M YEALY · 2017 to 2026
$2.4M
NCATS NIH HHS TL1 TR001858NHLBI NIH HHS T32 HL007820NHLBI NIH HHS T32 HL134615NINDS NIH HHS R01 NS119825NINDS NIH HHS R01 NS124642NINDS NIH HHS U24 NS100656NINDS NIH HHS U24 NS100659
6 · The paper itself

Abstract

backgroundCerebral edema after cardiac arrest can be quantified by the ratio of grey matter to white matter radiodensity (GWR) on computed tomography (CT). Severe edema predicts worse outcomes. We hypothesized the sensitivity and false positive rate of GWR predicting outcomes change over the first 24 hours post-arrest.

methodsWe performed a single-center retrospective cohort study including patients resuscitated from cardiac arrest between January 2010 and December 2023 who were unresponsive to verbal commands. We excluded patients who arrested from a primary traumatic or neurological etiology and those without brain imaging within 24 hours of arrest. We divided patients into groups based on time from arrest to CT, then quantified the performance of GWR dichotomized at <1.10 and <1.20, predicting in-hospital mortality and death by neurologic criteria (DNC).

resultsWe included 2,204 patients with mean age 59 (SD 16) years. Overall, 1651 (75%) died in the hospital, of whom 248 (11%) progressed to DNC. Sensitivity of GWR <1.10 and GWR <1.20 for predicting in-hospital mortality increased over the first four hours post-arrest, reaching a maximum of 25% after five hours, while false positive rates remained <5% at all time points. Similar temporal trends were observed with DNC, although absolute values of sensitivity and false positive rate (FPR) varied.

conclusionThe sensitivity and FPR of early GWR predicting in-hospital mortality and DNC after resuscitation from cardiac arrest varies over the initial post-arrest period. Reduced GWR on brain CTs is most sensitive for in-hospital mortality when obtained more than four hours post-arrest and for DNC when obtained between four and five hours. However, FPR remained execellent throughout, making early reductions in GWR a specific marker of poor outcome regardless of timing. While brain CTs obtained within the first 24 hours post-arrest may be indicated to evaluate for neurologic etiologies of arrest, they may be less informative as an independent marker of prognosis.

Indexed as

Brain EdemaGray MatterHeart ArrestTomography, X-Ray ComputedWhite MatterAgedCardiopulmonary ResuscitationFemaleHospital MortalityHumansMaleMiddle AgedPatient DischargePredictive Value of TestsPrognosisRetrospective StudiesAnoxic brain injuryBrain deathCardiac arrestComputed tomographyHeart arrestHypoxia, brainHypoxia–ischemia, brainHypoxic-ischemic brain injuryOutcome predictionPrognosisTomography, X-Ray Computed

Identifiers

PMID39592066
PMCPMC12538555

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.