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Neuron-Specific Enolase Predicts Poor Outcome After Cardiac Arrest and Targeted Temperature Management: A Multicenter

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  • 11Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.2Department of Anesthesia, Surgical and Internal Intensive Care, Emergency Medical Services, Klinikum Links der Weser, Bremen, Germany.3Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University, Innsbruck, Austria.4Department of Anesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy.5Department of Anesthesia and Intensive and Emergency Care, Evangelisches Waldkrankenhaus, Bonn, Germany.6Department for Biostatistics, Coordination Center for Clinical Trials, Charité Universitätsmedizin Berlin, Berlin, Germany.7Department of Nephrology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.

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High neuron-specific enolase levels reliably predict poor outcomes after cardiac arrest. Levels below 17 μg/L effectively rule out severe hypoxic-ischemic encephalopathy, aiding clinical decisions.

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Area of Science:

  • Neurology
  • Intensive Care Medicine
  • Biomarker Research

Background:

  • Accurate outcome prediction after cardiac arrest is crucial for intensive care decisions.
  • Neuron-specific enolase (NSE) is a potential prognostic biomarker, but its value after targeted temperature management is debated.
  • Conflicting results exist regarding NSE's prognostic accuracy in post-cardiac arrest care.

Purpose of the Study:

  • To evaluate the prognostic value of neuron-specific enolase (NSE) serum concentrations 3 days after cardiac arrest in patients treated with targeted temperature management.
  • To determine the accuracy of specific NSE thresholds in predicting neurological outcome (Cerebral Performance Category).
  • To compare the predictive performance of NSE in in-hospital versus out-of-hospital cardiac arrest patients.

Main Methods:

  • Analysis of NSE serum concentrations from 5 hospitals in Germany, Austria, and Italy.
  • Patients underwent targeted temperature management at 33°C for 24 hours following non-traumatic cardiac arrest.
  • Cerebral Performance Category (CPC) was assessed at ICU discharge; NSE levels were analyzed at 3 days post-arrest.

Main Results:

  • An NSE level >90 μg/L predicted poor outcome (CPC 4-5) with 99% positive predictive value and 0.5% false positive rate.
  • An NSE level ≤17 μg/L excluded poor outcome (CPC 4-5) with 92% negative predictive value.
  • Prediction accuracy was higher for out-of-hospital cardiac arrest than in-hospital cardiac arrest; NSE elevation confounders were identified.

Conclusions:

  • High NSE serum concentrations (>90 μg/L) are reliable predictors of poor neurological outcome post-cardiac arrest.
  • Low NSE serum concentrations (≤17 μg/L) argue against severe hypoxic-ischemic encephalopathy.
  • NSE's prognostic utility is influenced by cardiac arrest location (OHCA vs. IHCA) and requires consideration of confounding factors like hemolysis.