MRI Scoring Predicts Recovery in Cardiac Arrest Survivors

Brain imaging is an established tool in assessing neurological injury following out-of-hospital cardiac arrest (OHCA), but much of the research has focused on identifying irreversible damage or death. A recent study has shifted the focus to survivors, evaluating how a composite MRI score could predict functional neurological outcomes at the point of hospital discharge. Crucially, this score may help clinicians differentiate between levels of recovery potential, offering earlier and more nuanced insight into prognosis. 

Researchers retrospectively reviewed data from 42 OHCA survivors treated between 2017 and 2023 who underwent brain MRI within 2–7 days after cardiac arrest and survived to hospital discharge. The team developed a neuroprognostication (NP) score, ranging from 0–214, derived from specific signal abnormalities on diffusion-weighted imaging and FLAIR sequences across defined brain regions. Neurological outcomes were categorised using the Cerebral Performance Categories (CPC) scale: CPC 1–2 (independent), CPC 3 (dependent), and CPC 4 (vegetative state). Correlations between NP scores and outcomes were assessed using statistical analysis and computational modelling. 

Of the 42 patients (median age 47, 74% male), half regained independence (CPC 1–2), while 24% were dependent and 26% remained in a vegetative state at discharge. NP scores were strongly associated with outcomes (Spearman’s rs=0.69; p<0.001), with significant differences observed across CPC categories (p<0.001). Transition thresholds were identified: a score of 15 marked the divide between independence and dependency, while 54 distinguished dependency from vegetative state. Among patients with preserved bilateral somatosensory evoked potentials, median NP scores were 0 for independent, 29 for dependent, and 68.5 for vegetative patients, further reinforcing the score’s prognostic relevance. 

These findings suggest that quantitative brain MRI scoring could become a valuable tool in early neuroprognostication for OHCA survivors, helping guide discussions with families and informing rehabilitation planning. However, limitations include the small, single-centre sample and lack of long-term follow-up or inclusion of deceased patients. Broader validation in larger, multicentre cohorts is needed before the NP score can be integrated into clinical guidelines. Nevertheless, the results support more personalised and precise prognostication in post-cardiac arrest care. 

 

 

 

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The Role of Zinc in Predicting the Severity of COVID-19

It’s been over a year since the beginning of the Covid-19 pandemic, and we’ve certainly all learned a lot about this dangerous disease already. One question that keeps being brought up in both public and academic settings is, “Which factors predict the severity of Covid-19?” We all know that age and underlying health conditions play a certain role, but beyond that, little is known on the topic. 

 

Meanwhile, a significant number of individuals of comparable age and health status who contracted the virus exhibit a broad spectrum of health outcomes. A recent study that appears in the journal Nutrients suggests that low zinc levels may account for some of these unexpected severe cases of Covid-19. Read on to learn more about the link between zinc and Covid-19 infections. 

 

The role of zinc in the human body

We all need zinc to stay healthy. In fact, this essential mineral is involved in several key functions in the human body: wound healing, cell growth and division, the breakdown of carbohydrates, and DNA synthesis. Notably, zinc also plays a crucial role in immune health.

The mineral has both antiviral and anti-inflammatory properties, so it’s essential for maintaining the body’s defense against viruses specifically. Therefore, it’s logical to assume that low zinc levels could contribute to one’s risk of severe Covid-19 and hinder the recovery process. Interestingly, the category of people who have a higher risk of having low levels of zinc is senior citizens, the same age group that is disproportionately affected by the novel coronavirus. 

 

All these factors combined prompted the researchers at the Hospital del Mar Medical Research Institute and the Pompeu Fabra University (both in Spain) to investigate the correlation between the severity and progression of Covid-19 and zinc blood levels.

Dr. Robert Güerri-Fernández, one of the authors of the study, explained the mission of the study in a statement, “Zinc is an essential element for maintaining a variety of biological processes, and altering its levels causes increased susceptibility to infections and increased inflammatory response. […] zinc levels and zinc supplementation may prove useful tools to tackle the COVID-19 crisis.” More about the study below.

Can zinc levels influence the progression of COVID-19?  

Since zinc is involved in the immune response and curbs inflammation in the body, the researchers hypothesized that people with low zinc levels could suffer from more severe forms of Covid-19 and possibly even stay sick for a longer period of time. 

 

To test this idea, they looked at the data from 249 adult COVID-19 patients hospitalized between March 9 and April 1, 2020. 28% of the study participants were admitted to the intensive care unit, and 9% sadly passed away at the hospital. 

 

The researchers took blood zinc levels of each patient when they were admitted to the hospital. Of all the patients in the study, 23% had low zinc levels. These patients were more likely to have severe COVID-19 and higher levels of inflammatory markers in their blood than their counterparts with adequate zinc levels. Moreover, participants with low zinc levels had a mortality rate of 21% whereas those with healthy zinc levels had a 5% chance to pass as a result of COVID-19.

What’s more, those with normal zinc levels recovered 3 times faster than participants with low zinc levels - an average of 8 days and 25 days, respectively. These results seem to suggest that zinc deficiency increases one’s risks of severe COVID-19 and slows down recovery. 

 

To follow up on their findings, the researchers also conducted an in-vitro study confirming that higher zinc concentrations can indeed reduce the replication of the novel coronavirus. As Dr. Güerri-Fernández concluded in the study, “We have shown the importance of zinc levels in patients’ blood as an additional predictor of outcome in COVID-19, as well as its potential as a therapeutic tool for treatment.” 

 

Even though this study is considered quite small, so we cannot draw any definitive conclusions about it, it certainly urges us to be more mindful of our nutrition habits, just in case. Since the human body cannot produce zinc on its own, we should definitely make sure that we get enough of this mineral from our diet, especially now. 

 

Some foods that include plenty of zinc are pumpkin seeds, chocolate, turkey, egg yolks, and beef.  Lastly, if you know that you have a zinc deficiency, or suspect that you do, consult your doctor on the possibility of supplementation.

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New tool helps predict mortality risk in dementia patients

Researchers have developed a A new tool that predicts risk of death and admission to a long-term care facility for patients with dementia may help conversations between health care providers, patients and their families. The research has been published in the CMAJ - Canadian Medical Association Journal.

The recent tragic outbreaks of COVID-19 in long-term care homes highlight the need to have care discussions with residents and their caregivers.

"The majority of residents in long-term care homes have been diagnosed with dementia. Our study shows that the survival of many people with dementia is poor. It may be that many would choose care that focuses on comfort care and quality of life should they become acutely ill," says Dr. Peter Tanuseputro, a family physician and researcher with the Bruyère Research Institute, the Ottawa Hospital Research Institute and ICES, Ottawa, Ontario.

 

We have developed a tool that asks simple questions about a person at the time of dementia diagnosis and translates it to the chance of dying and of entering a nursing home over the next 5 years. This information can be used in conversations about what to expect," says Dr. Tanuseputro. "For newly diagnosed dementia patients and their families, personalized information about their trajectory may be helpful to plan for the future, including advance care planning and planning for additional supports."

The study used linked data from ICES on more than 108 000 people living in the community in Ontario who were newly diagnosed with dementia from 2010 through 2012.

 Researchers found that more than half of individuals (55%) died within 5 years -- comparable to many cancers -- and almost half of those who died (28%) lived in institutions. Only 1 in 4 people were still alive and living in the community 5 years after diagnosis.

Older age, male sex and presence of chronic obstructive pulmonary disease (COPD), congestive heart failure and kidney failure at the time of diagnosis of dementia were the most important factors that predicted death and admission to long-term care. The impact of organ failure on prognosis in people with dementia has not been well documented in other studies.  

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