Details

Autor(en) / Beteiligte

• Stammet, Pascal, MD
• Collignon, Olivier, PhD
• Hassager, Christian, MD, DMSc
• Wise, Matthew P., MD, DPhil
• Hovdenes, Jan, MD, PhD
• Åneman, Anders, MD, PhD
• Horn, Janneke, MD, PhD
• Devaux, Yvan, PhD
• Erlinge, David, MD, PhD
• Kjaergaard, Jesper, MD, DMSc
• Gasche, Yvan, MD
• Wanscher, Michael, MD, PhD
• Cronberg, Tobias, MD, PhD
• Friberg, Hans, MD, PhD
• Wetterslev, Jørn, MD, PhD
• Pellis, Tommaso, MD
• Kuiper, Michael, MD, PhD
• Gilson, Georges, PhD
• Nielsen, Niklas, MD, PhD

Titel

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

Ist Teil von

• Journal of the American College of Cardiology, 2015-05, Vol.65 (19), p.2104-2114

Ort / Verlag

United States: Elsevier Limited

Erscheinungsjahr

2015

Link zum Volltext

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Abstract Background 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. Objectives This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. Methods 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. Results 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. Conclusions 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 )