Does early gray-to-white matter ratio predict survival in post-cardiac arrest patients?

Dicle Birtane; Murat Aslan; Bahar Atasoy; Elif Hocaoğlu; Zafer Çukurova

Does early gray-to-white matter ratio predict survival in post-cardiac arrest patients?

Abstract

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.

Keywords

Supporting Institution

None

Ethical Statement

This study was approved by the Health Sciences University Bakırkoy Sadi Konuk Training and Research Hospital Clinical Research Local Ethics Committee with the decision number 2025-15-03 dated 20.08.2025, and was conducted in accordance with the Declaration of Helsinki, 2013.

Thanks

None

References

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Details

Primary Language

English

Subjects

Intensive Care

Journal Section

Research Article

Authors

Dicle Birtane ^*
0000-0002-9899-0545
Türkiye

Murat Aslan
0000-0002-0499-6859
Türkiye

Bahar Atasoy
0000-0002-5393-5876
Türkiye

Elif Hocaoğlu
0000-0002-2506-4794
Türkiye

Zafer Çukurova
0000-0002-8893-3977
Türkiye

Publication Date

June 25, 2026

Submission Date

May 6, 2026

Acceptance Date

June 23, 2026

Published in Issue

Year 2026 Volume: 7 Number: 3

IZ

https://izlik.org/JA62TW26HN

Cite

RIS / Bibtex

APA

Birtane, D., Aslan, M., Atasoy, B., Hocaoğlu, E., & Çukurova, Z. (2026). Does early gray-to-white matter ratio predict survival in post-cardiac arrest patients? Journal of Medicine and Palliative Care, 7(3), 633-642. https://izlik.org/JA62TW26HN

AMA

1.Birtane D, Aslan M, Atasoy B, Hocaoğlu E, Çukurova Z. Does early gray-to-white matter ratio predict survival in post-cardiac arrest patients? J Med Palliat Care / JOMPAC / jompac. 2026;7(3):633-642. https://izlik.org/JA62TW26HN

Chicago

Birtane, Dicle, Murat Aslan, Bahar Atasoy, Elif Hocaoğlu, and Zafer Çukurova. 2026. “Does Early Gray-to-White Matter Ratio Predict Survival in Post-Cardiac Arrest Patients?”. Journal of Medicine and Palliative Care 7 (3): 633-42. https://izlik.org/JA62TW26HN.

EndNote

Birtane D, Aslan M, Atasoy B, Hocaoğlu E, Çukurova Z (June 1, 2026) Does early gray-to-white matter ratio predict survival in post-cardiac arrest patients? Journal of Medicine and Palliative Care 7 3 633–642.

IEEE

[1]D. Birtane, M. Aslan, B. Atasoy, E. Hocaoğlu, and Z. Çukurova, “Does early gray-to-white matter ratio predict survival in post-cardiac arrest patients?”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 3, pp. 633–642, June 2026, [Online]. Available: https://izlik.org/JA62TW26HN

ISNAD

Birtane, Dicle - Aslan, Murat - Atasoy, Bahar - Hocaoğlu, Elif - Çukurova, Zafer. “Does Early Gray-to-White Matter Ratio Predict Survival in Post-Cardiac Arrest Patients?”. Journal of Medicine and Palliative Care 7/3 (June 1, 2026): 633-642. https://izlik.org/JA62TW26HN.

JAMA

1.Birtane D, Aslan M, Atasoy B, Hocaoğlu E, Çukurova Z. Does early gray-to-white matter ratio predict survival in post-cardiac arrest patients? J Med Palliat Care / JOMPAC / jompac. 2026;7:633–642.

MLA

Birtane, Dicle, et al. “Does Early Gray-to-White Matter Ratio Predict Survival in Post-Cardiac Arrest Patients?”. Journal of Medicine and Palliative Care, vol. 7, no. 3, June 2026, pp. 633-42, https://izlik.org/JA62TW26HN.

Vancouver

1.Dicle Birtane, Murat Aslan, Bahar Atasoy, Elif Hocaoğlu, Zafer Çukurova. Does early gray-to-white matter ratio predict survival in post-cardiac arrest patients? J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Jun. 1;7(3):633-42. Available from: https://izlik.org/JA62TW26HN