Significantly associated with an increase in good neurologic outcomes (OR, 1.66; 95 CI

Significantly associated with an increase in good neurologic outcomes (OR, 1.66; 95 CI, 1.30 to 2.12; multivariate logistic regression using backward elimination; P < 0.001). We also evaluated the sensitivity and specificity of different oxy-Hb, rSO2, Hb, and base excess cut-off values among the entire cohort. ROC analysis revealed cut-offs providing optimal sensitivity and specificity to predict good neurologic outcomes at 90 days, which are summarized in Table 3. In this cohort, oxy-Hb was the most reliable neurologic prognostic index, with significant advantages over rSO2, Hb, and base excess (P < 0.001, Table 3 and Figure 5). Finally, we classified patients into four groups by oxyHb and rSO2 quartiles to assess the relation between these quartiles and the primary outcomes in the subgroups of patients with and without ROSC at hospital arrival. In the subgroup of patients with sustained cardiac arrest at hospital arrival, a significant trend was found for a good neurologic outcome with increasing oxy-Hb levels and rSO2 (Figure 6a). Of the 119 comatose patients with ROSC at hospital arrival, 55 (46.2 ) had a good outcome at 90 days after cardiac arrest. EvenFigure 4 The relation between estimated oxy-Hb at hospital arrival and cerebral performance category. CPC, cerebral performance category; Oxy-Hb, oxyhemoglobin.Oxy-HbHayashida et al. Critical Care 2014, 18:500 http://ccforum.com/content/18/5/Page 7 ofTable 3 Optimal cut-off value of oxy-Hb, rSO2, Hb, and base excess at hospital arrival for predicting a good neurologic outcome at 90 daysVariables Oxy-Hb rSO2 Hb Base excess Optimal cut-off 5.5 40 13.0 g/dl -18.7 mM AUC (95 CIs) 0.87 (0.83 ?0.91) 0.83 (0.78 ?0.88) 0.77 (0.70 ?0.81) 0.68 (0.63 ?0.74) Sensitivity (95 CIs) 77.3 (72.4 ?82.1) 80.0 (75.3 ?84.6) 73.3 (68.1 ?78.4) 96.0 (93.7 ?98.2) Specificity (95 CIs) 85.0 (83.2 ?86.7) 78.6 (76.5 ?80.6) 70.2 (69.7 ?72.4) 37.4 (35.0 ?39.7) PPV 47.9 40.0 30.5 21.4 NPV 95.4 95.6 93.6 Capecitabine 98.1 P value (versus Oxy-Hb) N/A < 0.001 < 0.001 < 0.AUC, area under the curve; CI, confidence interval; Hb, hemoglobin, NPV, negative predictive value; Oxy-Hb, oxyhemoglobin; PPV, positive predictive value; rSO2, regional cerebral oxygen saturation.in this subgroup, the trend was significant for good neurologic outcomes across increasing oxy-Hb quartiles (1st quartile, 0; 2nd quartile, 16.7 ; 3rd quartile, 29.4 ; 4th quartile, 53.3 ; Cochran rmitage trend test, P < 0.05) but not across rSO2 quartiles (12.5 , 0; 50.0 , and 48.4 , respectively; P = 0.14) (Figure 6b). In this subgroup, AUC to predict good neurologic outcomes at 90 days for oxy-Hb PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/16989806 (AUC, 0.67; 95 CI, 0.58 to 0.77; P = 0.001) was superior to that for rSO2 (AUC, 0.56; 95 CI, 0.45 to 0.66; P > 0.05).Discussion In this study, the estimated cerebral oxy-Hb level on hospital arrival was a valid indicator of 90-day neurologic outcome in patients who successfully achieved ROSC from OHCA. The estimated oxy-Hb level was easily and immediately obtained on hospital arrival. We verified the hypothesis that oxy-Hb is associated with neuroprotection in patients with PCAS on the basis of the theoretical assumption that the product of Hb and rSO2 may reflect cerebral tissue oxy-Hb levels. Multivariate analyses** *Oxy-Hb: AUC 0.87, 95 CI (0.83 ?0.91)Figure 5 AUC of each potential indicator for predicting neurologic outcome at 90 days. The area under the receiver operating characteristic curve (AUC) of each potential indicator to predict good neuro.