Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C

• Published in: Journal of the American College of Cardiology Vol. 65; no. 19; pp. 2104 - 2114
• Main Authors: Stammet, Pascal, Collignon, Olivier, Hassager, Christian, Wise, Matthew P., Hovdenes, Jan, Åneman, Anders, Horn, Janneke, Devaux, Yvan, Erlinge, David, Kjaergaard, Jesper, Gasche, Yvan, Wanscher, Michael, Cronberg, Tobias, Friberg, Hans, Wetterslev, Jørn, Pellis, Tommaso, Kuiper, Michael, Gilson, Georges, Nielsen, Niklas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 19.05.2015; Elsevier Limited
• Subjects: biomarker; Biomarkers - blood; Brain damage; Brain Ischemia - enzymology; Brain Ischemia - epidemiology; Brain Ischemia - etiology; Cardiology; Cardiology and Cardiovascular Disease; Cardiovascular; cerebral performance; Clinical Medicine; Confidence intervals; Europe - epidemiology; Female; Follow-Up Studies; Heart attacks; Humans; Hypothermia, Induced - methods; Incidence; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Laboratories; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Mortality; neuroprognostication; Out-of-Hospital Cardiac Arrest - complications; Out-of-Hospital Cardiac Arrest - enzymology; Out-of-Hospital Cardiac Arrest - mortality; Phosphopyruvate Hydratase - blood; Prognosis; Prospective Studies; Statistical analysis; Temperature; Treatment Outcome; Europe; NSE; OHCA; NRI; CPC; neuroprognostication; FPR; ICU; ROSC; biomarker; cerebral performance; prognosis; IDI; cerebral performance category; false positive rate; neuron-specific enolase; return of spontaneous circulation; integrated discrimination improvement; net reclassification index; out-of-hospital cardiac arrest; intensive care unit
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.03.538

Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. A total of 686 patients hospitalized after OHCA were randomized to targeted temperature management at either 33°C or 36°C. NSE levels were assessed in blood samples obtained 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was neurological outcome at 6 months using the cerebral performance category score. NSE was a robust predictor of neurological outcome in a baseline variable-adjusted model, and target temperature did not significantly affect NSE values. Median NSE values were 18 ng/ml versus 35 ng/ml, 15 ng/ml versus 61 ng/ml, and 12 ng/ml versus 54 ng/ml for good versus poor outcome at 24, 48, and 72 h, respectively (p < 0.001). At 48 and 72 h, NSE predicted neurological outcome with areas under the receiver-operating curve of 0.85 and 0.86, respectively. High NSE cutoff values with false positive rates ≤5% and tight 95% confidence intervals were able to reliably predict outcome. High, serial NSE values are strong predictors of poor outcome after OHCA. Targeted temperature management at 33°C or 36°C does not significantly affect NSE levels. (Target Temperature Management After Cardiac Arrest [TTM]; NCT01020916)