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The Modified Glasgow Outcome Score for the prediction of outcome in patients after cardiac arrest: a prospective clinical proof of concept study

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Abstract

The Glasgow–Pittsburgh cerebral performance categories (GP-CPC) and the Glasgow Outcome Score (GOS) have been used to categorize patients according to their neurological outcome for prognostic predictors in patients after cardiac arrest (CA). We postulated that inclusion of deaths without knowing the cerebral status into the group of patients with poor outcome after CA using the GP-CPC and GOS will lead to dilution of the prognostic power of the investigated biochemical marker. The present study was conducted to verify this issue by employing a modified outcome score, which we termed as Modified Glasgow Outcome Score (MGOS). In the present study, 97 patients were enrolled in a prospective manner. Serum NSE and S100B levels were measured daily for 7 days after admission to the intensive care unit. Neurological outcome was assessed by employing the GOS and MGOS after 6 months. By employing the GOS, 46 patients were categorized into the group of patients with poor outcome and 51 patients survived with good neurological outcome. Patients who died without certified brain damage or with unknown cerebral status after CA (n = 20) were separated from patients with poor outcome in the MGOS. The magnitude of NSE (S100B) elevation in patients with poor outcome categorized by the MGOS was approximately 1.7-fold (1.5) higher as compared with patients divided by the GOS. The mean calculated sensitivities and area under the curve values of NSE and S100B predicting poor outcome classified by the MGOS were significantly higher as compared with the GOS. Conclusively, inclusion of deaths without certified brain damage or with unknown cerebral status into the group of patients with poor outcome will lead to underestimation of the prognostic power of investigated biochemical markers such as NSE and S100B. The MGOS will help to avoid this bias.

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Acknowledgments

We would like to thank the medical and nursing staff of the ICU of the Medical Clinic I, Department of Cardiology, RWTH Aachen University, Germany, for supporting this study. This work contains data from the doctoral thesis of Julia S. Kühnen, RWTH Aachen University, Germany.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany

    Obaida R. Rana, Malte Kelm, Christian Meyer & Erol Saygili

  2. Department of Cardiology, RWTH Aachen University, Aachen, Germany

    Jörg W. Schröder, Julia S. Kühnen, Esra Saygili, Christopher Gemein, Matthias D. H. Zink, Patrick Schauerte & Nikolaus Marx

  3. Department of Neurology, RWTH Aachen University, Aachen, Germany

    Johannes Schiefer

  4. Medical Clinic II, Klinikum Weiden, Weiden, Germany

    Robert H. G. Schwinger

  5. Institute of Neuropathology, RWTH Aachen University, Aachen, Germany

    Joachim Weis

Authors
  1. Obaida R. Rana
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  2. Jörg W. Schröder
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  3. Julia S. Kühnen
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  4. Esra Saygili
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  6. Matthias D. H. Zink
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  7. Patrick Schauerte
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  8. Johannes Schiefer
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  9. Robert H. G. Schwinger
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  10. Joachim Weis
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  11. Nikolaus Marx
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  12. Malte Kelm
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  13. Christian Meyer
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  14. Erol Saygili
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Corresponding author

Correspondence to Obaida R. Rana.

Additional information

O. R. Rana and J. W. Schröder contributed equally to this work.

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Rana, O.R., Schröder, J.W., Kühnen, J.S. et al. The Modified Glasgow Outcome Score for the prediction of outcome in patients after cardiac arrest: a prospective clinical proof of concept study. Clin Res Cardiol 101, 533–543 (2012). https://doi.org/10.1007/s00392-012-0423-7

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  • DOI: https://doi.org/10.1007/s00392-012-0423-7

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