Dicle BIRTANE, Murat ASLAN, Bahar ATASOY, Elif HOCAOĞLU, Zafer ÇUKUROVA
Journal of Medicine and Palliative Care - 2026;7(3):633-642
Aims: Early brain computed tomography following cardiac arrest can reveal alterations in gray-to-white matter differentiation, offering potentially important prognostic insights into neurological outcomes. This study examined the relationship between gray-to-white matter ratio (GWR) metrics and survival. Methods: Patients managed in the intensive care unit after cardiopulmonary resuscitation (CPR) between 2015 and 2025 were retrospectively reviewed. Patients aged >18 years, with witnessed in-hospital or out-of-hospital CPR and those with cranial CT scans within the first 48 hours after cardiac arrest, were included. To assess the association with survival, GWR measurements were calculated in six different regions across both hemispheres. Results: Overall, normal-range GWR measurements were observed across the cohort, with no statistically significant impact on survival outcomes. Independent risk factors for two-day survival were age (OR 1.039; p=0.005), absent pupillary light reflex (OR 5.43; p<0.001), elevated lactate (OR 1.177; p=0.001) and requirement for combined norepinephrine and inotropic support (OR 4.40; p=0.008). For 1-month survival, age (OR 1.030; p=0.015) and CPR duration (OR 1.054; p=0.023) were independent predictors. Neurological status at discharge differed significantly between groups, with higher discharge GCS scores observed in IHCA patients (7 [3-12] vs. 3 [3-5], p=0.001). Conclusion: Computed tomography-derived GWR values alone demonstrated limited predictive power for survival. However, they may contribute meaningfully to clinical decision-making when incorporated into a multimodal prognostic framework. They are difficult to adapt to every population and should be evaluated multimodally with larger sample sizes.
