Biochemical markers and somatosensory evoked potentials in patients after cardiac arrest: The role of neurological outcome scores

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

“…AUC denotes area under the curve constellation and the unclear neurological state of its patients, the time course of the biomarkers NSE and S100B in the MGOS 0 group, which resembles the one in the good outcome group (MGOS 3-5), may not be reliable for further interpretations and conclusions. We recently demonstrated that on average, mean NSE cut-off values and sensitivities were higher (56 ± 35 ng/ ml, 56 ± 18%) in studies excluding patients with unknown cerebral outcome compared with studies which included all patients who died into the category of poor outcome (41 ± 17 ng/ml, 44 ± 25%) [6]. This is partly in line with the results of the present study.…”

“…The main difference between both scores lies in the fact that GOS does not further differentiate the cause of death in GOS 1, whereas GP-CPC 5 acknowledges death as certified brain death or death by traditional criteria. Because of the unspecific definition of GP-CPC 5, consequently, most studies investigating biochemical markers or somatosensory evoked potentials (SSEP) for the prediction of neurological outcome included patients who died either from primary brain damage or death from any cause into this category [6]. Thus, no profound difference is found between both outcome groups, and both outcome groups are yet used in clinical studies evaluating the prediction power of biochemical markers or SSEP [13][14][15][16].…”

“…However, we recently have demonstrated that several studies evaluating biochemical markers and electrophysiological techniques for the prediction of outcome after CA are based on the Glasgow Outcome Score (GOS) [6]. Although both scores provide comparative categories, a significant number of outcome studies using the GOS do not include patients with severe cerebral disability (GOS 3) to the category of poor outcome [6]. In contrast, studies applying the GP-CPC included patients with severe cerebral disability (GP-CPC 3) to the group of patients with poor outcome.…”

“…Furthermore, while the GP-CPC defines death, certified brain death, or death by traditional criteria as worst category (GP-CPC 5), the GOS is less specific and defines the worst outcome level (GOS 1) simply as death irrespective of whether this was due to brain damage or other causes or a combination of both [5,7]. Unfortunately, many clinical studies using the GP-CPC did not restrict GP-CPC category five only to certified brain death, which may have diluted sensitivity of this score and its parameters to predict the individual neurologic outcome [6]. We have recently postulated that inclusion of deaths without certified brain damage to the group of patients with poor outcome will lead to underestimation of sensitivity and cut-off values of NSE for the prediction of poor outcome [6].…”

“…Unfortunately, many clinical studies using the GP-CPC did not restrict GP-CPC category five only to certified brain death, which may have diluted sensitivity of this score and its parameters to predict the individual neurologic outcome [6]. We have recently postulated that inclusion of deaths without certified brain damage to the group of patients with poor outcome will lead to underestimation of sensitivity and cut-off values of NSE for the prediction of poor outcome [6]. We speculated that a modified GOS or GP-CPC score might help to avoid this bias.…”