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cardiac arrest resuscitation is complex. Clinical variables, as well as biomarkers of brain injury, cardiac injury, and systemic inflammation, all yield some prognostic value. We hypothesised that cumulative information obtained during the first three days of intensive care could produce a reliable model for predicting neurological outcome following out-of-hospital cardiac arrest (OHCA) using artificial neural network (ANN) with and without biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a post hoc analysis of 932 patients from the Target Temperature Management trial. We focused on comatose patients at 24, 48, and 72\u00a0h post-cardiac arrest and excluded patients who were awake or deceased at these time points. 80% of the patients were allocated for model development (training set) and 20% for internal validation (test set). To investigate the prognostic potential of different levels of biomarkers (clinically available and research-grade), patients\u2019 background information, and intensive care observation and treatment, we created three models for each time point: (1) clinical variables, (2) adding clinically accessible biomarkers, e.g., neuron-specific enolase (NSE) and (3) adding research-grade biomarkers, e.g., neurofilament light (NFL). Patient outcome was the dichotomised Cerebral Performance Category (CPC) at six months; a good outcome was defined as CPC 1\u20132 whilst a poor outcome was defined as CPC 3\u20135. The area under the receiver operating characteristic curve (AUROC) was calculated for all test sets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      AUROC remained below 90% when using only clinical variables throughout the first three days in the ICU. Adding clinically accessible biomarkers such as NSE, AUROC increased from 82 to 94% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). The prognostic accuracy remained excellent from day 1 to day 3 with an AUROC at approximately 95% when adding research-grade biomarkers. The models which included NSE after 72\u00a0h and NFL on any of the three days had a low risk of false-positive predictions while retaining a low number of false-negative predictions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this exploratory study, ANNs provided good to excellent prognostic accuracy in predicting neurological outcome in comatose patients post OHCA. The models which included NSE after 72\u00a0h and NFL on all days showed promising prognostic performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13054-021-03505-9","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T06:04:41Z","timestamp":1614233081000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Predicting neurological outcome after out-of-hospital cardiac arrest with cumulative information; development and internal validation of an artificial neural network algorithm"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8261-9613","authenticated-orcid":false,"given":"Peder","family":"Andersson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Johnsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Bj\u00f6rnsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Cronberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hassager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Zetterberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Stammet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Und\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Kjaergaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Friberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaj","family":"Blennow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisela","family":"Lilja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt P.","family":"Wise","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Dankiewicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila","family":"Frigyesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"issue":"7","key":"3505_CR1","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/S1474-4422(20)30117-4","volume":"19","author":"T Cronberg","year":"2020","unstructured":"Cronberg T, Greer DM, Lilja G, Moulaert V, Swindell P, Rossetti AO. 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Eur Heart J. 2020.","DOI":"10.1101\/2020.04.12.20045146"}],"container-title":["Critical Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-021-03505-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13054-021-03505-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-021-03505-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T06:22:50Z","timestamp":1614234170000},"score":1,"resource":{"primary":{"URL":"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/s13054-021-03505-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,25]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["3505"],"URL":"https:\/\/doi.org\/10.1186\/s13054-021-03505-9","relation":{},"ISSN":["1364-8535"],"issn-type":[{"value":"1364-8535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,25]]},"assertion":[{"value":"18 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The TTM-trial protocol was approved by ethics committees in the following institutions: St George Hospital, Sydney, Australia; North Shore Hospital, Sydney, Australia; Liverpool Hospital, Sydney, Australia; The George Institute of Global Health, Sydney, Australia; General University Hospital in Prague, Prague, Czech Republic; The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Ospedale Universitario di Cattinara, Trieste, Italy; Santa Maria degli Angeli Hospital, Pordenone, Italy; San Martino, Italy; National ethics committee on research, Luxembourg; Amsterdam Medical Centre, Amsterdam, the Netherlands; Leeuwarden Hospital, Leeuwarden, the Netherlands; Rijnstaate Hospital, Arnhem, the Netherlands; Onze Lieuwe Vrouwe Gasthuis, Amsterdam, the Netherlands; Oslo University Hospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Helsingborg Hospital, Helsingborg, Sweden; Karlstad Hospital, Karlstad, Sweden; Kung\u00e4lv Hospital, Kung\u00e4lv, Sweden; Link\u00f6ping University Hospital, Link\u00f6ping, Sweden; Sk\u00e5ne University Hospital, Lund, Sweden; Sk\u00e5ne University Hospital, Malm\u00f6, Sweden; Norra \u00c4lvsborgs L\u00e4n Hospital, Sweden; Vrinnevi Hospital, Norrk\u00f6ping, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; \u00d6rebro University Hospital, \u00d6rebro, Sweden; Geneva University Hospital, Geneva, Switzerland; Hospital St.Gallen, St. Gallen, Switzerland; Hospital La Chaux de Fonds, Switzerland; University Hospital of Wales, Cardiff, UK; Royal Berkshire Hospital, Reading, UK; Royal Bournemouth Hospital, Bournemouth, UK; Guy\u2019s and St Thomas\u2019 NHS Trust, London, UK; and St George\u2019s Hospital, London, UK. Informed consent was waived or was obtained according to national legislation, in line with the Helsinki declaration.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"HZ has served at scientific advisory boards for Denali, Roche Diagnostics, Wave, Samumed, Siemens Healthineers, Pinteon Therapeutics and CogRx, has given lectures in symposia sponsored by Fujirebio, Alzecure and Biogen, and is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program. KB has served as a consultant, at advisory boards, or at data monitoring committees for Abcam, Axon, Biogen, JOMDD\/Shimadzu. Julius Clinical, Lilly, MagQu, Novartis, Roche Diagnostics, and Siemens Healthineers, and is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program. The other authors declare that they have no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"83"}}