Critical care medicine · 2026
Correlation Between Quantitative Pupillometry and Other Markers for Neuroprognostication of Comatose Patients After Cardiac Arrest: A Bicentric Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Benghanem Sarah, Novy Jan, Cariou Alain, Ben-Hamouda Nawfel, Rossetti Andréa O
Аннотация
OBJECTIVES: The prognostic role of quantitative pupillometry in comatose patients after cardiac arrest (CA) has been recently described, but data on quantitative pupillary light reflex (qPLR) are limited, especially in a multimodal approach and regarding good outcome. We assessed qPLR correlations with clinical features, electroencephalogram (EEG), somatosensory evoked potentials (SSEPs), and neuron-specific enolase (NSE), as well as qPLR prognostic values toward poor and good outcomes.
DESIGN, SETTINGS, AND PATIENTS: Bicentric study (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland and Cochin Hospital, Paris, France), analyzing prospective registries of comatose adults with pupillometry parameters obtained during the first 48-72 hours after CA. Neurological Pupil index (NPi), lowest (minimum qPLR), and highest values (maximum qPLR) of qPLR were collected. Predictive performances in terms of Cerebral Performance Categories (CPCs) level at 3 months (good outcome: CPC 1-2) were calculated.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Between 2020 and 2024, 442 patients were included. Minimum and maximum qPLRs were significantly lower in case of early myoclonus ( p < 0.001), bilateral N20 SSEP absence ( p < 0.001), unreactive EEG ( p < 0.001), and epileptiform EEG ( p = 0.03 and 0.05). qPLR was also significantly lower with suppressed EEG, compared with discontinuous and continuous background ( p < 0.001). Serum NSE level at 48 hours was significantly correlated with minimum (Spearman Rho = -0.283; p < 0.001) and maximum qPLRs ( R = -0.444; p < 0.001). Minimum qPLR less than 2% (96.4% specificity, 23.6% sensitivity), maximum qPLR less than 13% (96.4% specificity, 19.0% sensitivity), and NPi less than or equal to 2 (99% specificity, 34% sensitivity) robustly correlated with poor outcome. Notably, qualitative PLR had higher sensitivity than minimum and maximum qPLRs (38.9 vs. 23.6 and 19.0%, respectively; p < 0.001) with comparable specificity. A minimum qPLR greater than 9.5% (83.2% specificity, 31.1% sensitivity) and a maximum qPLR greater than 25.5% (62.2% specificity, 65.5% sensitivity) correlated with good outcome.
CONCLUSIONS: In comatose patients after CA, qPLR is tightly correlated with other prognostic markers; low qPLR and NPi less than or equal to 2 appeared highly specific for poor outcome, but performances do not exceed that of clinical PLR. Finally, high qPLR remained limited in predicting a good outcome.
DESIGN, SETTINGS, AND PATIENTS: Bicentric study (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland and Cochin Hospital, Paris, France), analyzing prospective registries of comatose adults with pupillometry parameters obtained during the first 48-72 hours after CA. Neurological Pupil index (NPi), lowest (minimum qPLR), and highest values (maximum qPLR) of qPLR were collected. Predictive performances in terms of Cerebral Performance Categories (CPCs) level at 3 months (good outcome: CPC 1-2) were calculated.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Between 2020 and 2024, 442 patients were included. Minimum and maximum qPLRs were significantly lower in case of early myoclonus ( p < 0.001), bilateral N20 SSEP absence ( p < 0.001), unreactive EEG ( p < 0.001), and epileptiform EEG ( p = 0.03 and 0.05). qPLR was also significantly lower with suppressed EEG, compared with discontinuous and continuous background ( p < 0.001). Serum NSE level at 48 hours was significantly correlated with minimum (Spearman Rho = -0.283; p < 0.001) and maximum qPLRs ( R = -0.444; p < 0.001). Minimum qPLR less than 2% (96.4% specificity, 23.6% sensitivity), maximum qPLR less than 13% (96.4% specificity, 19.0% sensitivity), and NPi less than or equal to 2 (99% specificity, 34% sensitivity) robustly correlated with poor outcome. Notably, qualitative PLR had higher sensitivity than minimum and maximum qPLRs (38.9 vs. 23.6 and 19.0%, respectively; p < 0.001) with comparable specificity. A minimum qPLR greater than 9.5% (83.2% specificity, 31.1% sensitivity) and a maximum qPLR greater than 25.5% (62.2% specificity, 65.5% sensitivity) correlated with good outcome.
CONCLUSIONS: In comatose patients after CA, qPLR is tightly correlated with other prognostic markers; low qPLR and NPi less than or equal to 2 appeared highly specific for poor outcome, but performances do not exceed that of clinical PLR. Finally, high qPLR remained limited in predicting a good outcome.