scholarly journals Neuron-specific enolase level as a predictor of neurological outcome in near-hanging patients: A retrospective multicenter study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246898
Author(s):  
Dongwook Lee ◽  
Yongil Cho ◽  
Yujin Ko ◽  
Nam Hun Heo ◽  
Hyung Goo Kang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Multicenter Study ◽  
Neurological Outcome ◽  
Independent Predictor ◽  
Neuron Specific Enolase ◽  
High Serum ◽  
Neurological Outcomes ◽  
Hypoxic Brain ◽  
Poor Neurological Outcome ◽  
Retrospective Multicenter Study

Objectives Neuron-specific enolase (NSE) is frequently used to predict neurological outcomes in patients with hypoxic brain injury. Hanging can cause hypoxic brain damage, and survivors can suffer from neurological deficits that may impair daily activities. Here, we investigated the utility of the initial serum NSE level as a predictor of neurological outcomes in near-hanging patients with decreased consciousness. Methods This retrospective multicenter study was conducted in patients who visited the emergency department due to near-hanging injury from October 2013 to February 2019 at three university hospitals in Korea. They were divided into two groups according to the presence of out-of-hospital cardiac arrest. The neurological outcome was determined using the Cerebral Performance Category (CPC) measured at the time of discharge. Multivariate analysis was performed to determine whether initial serum NSE is an independent predictor of neurological outcome. Results Of the 70 patients included in the study, 44 showed a poor neurological outcome (CPC score = 3–5). Among the 52 patients with cardiac arrest, only 10 (19.2%) were discharged with good neurological outcome (CPC score = 1–2). In the whole cohort, a high serum NSE level was a significant predictor of poor neurological outcome (odds ratio [OR], 1.343; 95% confidence interval [CI], 1.003–1.800, p = 0.048). Among the patients with cardiac arrest, a high serum NSE level was a significant predictor of poor neurological outcome (OR, 1.138; 95% CI, 1.009–1.284, p = 0.036). Conclusions In near-hanging patients, a high initial serum NSE level is an independent predictor of poor neurological outcome.

Usefulness of the Degree of Blood–brain Barrier Disruption to Predict Neurological Prognosis in Cardiac Arrest Survivors who Wnderwent Target Temperature Management: A Retrospective Study

2020 ◽  
Author(s):  
Ga Ram Jeon ◽  
Hong Joon Ahn ◽  
Jung Soo Park ◽  
Insool Yoo ◽  
Yeonho You ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Blood Brain Barrier ◽  
Neurological Outcome ◽  
Scoring System ◽  
Brain Barrier ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome

Abstract Background: This study aimed to compare the day-specific association of blood–brain barrier (BBB) disruption with neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with target temperature management (TTM).Methods: This retrospective single-center study included 68 OHCA survivors, who underwent TTM between April 2018 and December 2019. The albumin quotient (QA) was calculated as [albuminCSF] / [albuminserum] immediately (day 1), and at 24 h (day 2), 48 h (day 3), and 72 h (day 4) after return of spontaneous circulation (ROSC). The degree of BBB disruption was weighted using the following scoring system: 0.07 ≥ QA (normal), 0.01 ≥ QA > 0.007 (mild), 0.02 ≥ QA > 0.01 (moderate), and QA > 0.02 (severe). This system gave it 0 (normal), 1 (mild), 4 (moderate), and 9 (severe) points. Poor neurological outcome was determined at six months after ROSC and was defined as cerebral performance categories 3–5.Results: We enrolled 68 patients (males, 48; 71%); 37 (54%) of them had a poor neurological outcome. The distributions of this outcome at six months in patients with moderate and severe BBB disruption versus the other groups were 19/22 (80%) vs. 18/46 (50%) on day 1, 31/37 (79%) vs. 6/31 (32%) on day 2, 32/37 (81%) vs. 5/31 (30%) on day 3, and 32/39 (85%) vs. 5/29 (30%) on day 4 (P < 0.001). Using ROC analyses, the optimal cutoff values of QA levels for prediction of neurological outcomes were determined as: day 1, > 0.009 (sensitivity 56.8%, specificity 87.1%); day 2, > 0.012 (sensitivity 81.1%, specificity 87.1%); day 3, > 0.013 (sensitivity 83.8%, specificity 87.1%); day 4, > 0.013 (sensitivity 86.5%, specificity 87.1%); sum of all time points, > 0.039 (sensitivity 89.5%, specificity 79.4%); and scoring system, > 9 (sensitivity 91.9%, specificity 87.1%). Conclusions: Our results suggested that QA is a useful tool for predicting neurological outcomes in OHCA survivors treated with TTM. However, the prediction of poor neurological outcome using QA showed low sensitivity at 100% specificity. Thus, it could be used as part of a multimodal approach than as a single prognostic prediction tool.

scholarly journals The Usefulness of Quantitative Analysis of Blood-Brain Barrier Disruption Measured Using Contrast-Enhanced Magnetic Resonance Imaging to Predict Neurological Prognosis in Out-of-Hospital Cardiac Arrest Survivors: A Preliminary Study

2020 ◽  
Vol 9 (9) ◽  
pp. 3013
Author(s):  
Ho Il Kim ◽  
In Ho Lee ◽  
Jung Soo Park ◽  
Da Mi Kim ◽  
Yeonho You ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Arrest ◽  
Magnetic Resonance ◽  
Neurological Outcome ◽  
Resonance Imaging ◽  
Neurological Outcomes ◽  
Outcome Group ◽  
Contrast Enhanced ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

We aimed to evaluate neurological outcomes associated with blood-brain barrier (BBB) disruption using contrast-enhanced magnetic resonance imaging (CE-MRI) in out-of-hospital cardiac arrest (OHCA) survivors. This retrospective observational study involved OHCA survivors who had undergone CE-MRI for prognostication. Qualitative and quantitative analyses were performed using the presence of BBB disruption (pBD) and the BBB disruption score (sBD) in CE-MRI scans, respectively. For the sBD, 1 point was assigned for each area of BBB disruption, and 6 points were assigned when an absence of intracranial blood flow due to severe brain oedema was confirmed. The primary outcome was poor neurological outcome at 3 months (defined as cerebral performance categories 3–5). We analysed 46 CE-MRI brain scans (27 patients). Of these, 15 (55.6%) patients had poor neurological outcomes. Poor neurological outcome group patients showed a significantly higher proportion of pBD than those in the good neurological outcome group (22 (88%) vs. 6 (28.6%) patients, respectively, p < 0.001) and a higher sBD (5.0 (4.0–5.0) vs. 0.0 (0.0–1.0) patients, p < 0.001). Poor neurological outcome predictions showed that the sBD had a significantly better prognostic performance (area under the curve (AUC) 0.95, 95% confidence interval (CI) 0.84–0.99) than the pBD (AUC 0.80, 95% CI 0.65–0.90). The sBD cut-off value was >1 point (sensitivity, 96.0%; specificity, 81.0%). The sBD is a highly predictive and sensitive marker of 3-month poor neurological outcome in OHCA survivors. Multicentre prospective studies are required to determine the generalisability of these results.

scholarly journals Neuromarkers and neurological outcome in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia–experience from the HAnnover COoling REgistry (HACORE)

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245210
Author(s):  
Muharrem Akin ◽  
Vera Garcheva ◽  
Jan-Thorben Sieweke ◽  
John Adel ◽  
Ulrike Flierl ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Clinical Decision Making ◽  
Cerebral Performance Category ◽  
Neuron Specific Enolase ◽  
Clinical Decision ◽  
St Segment Elevation ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

Background Neuron-specific enolase (NSE) and S-100b have been used to assess neurological damage following out-of-hospital cardiac arrest (OHCA). Cut-offs were derived from small normothermic cohorts. Whether similar cut-offs apply to patients treated with hypothermia remained undetermined. Methods We investigated 251 patients with OHCA treated with hypothermia but without routine prognostication. Neuromarkers were determined at day 3, neurological outcome was assessed after hospital discharge by cerebral performance category (CPC). Results Good neurological outcome (CPC≤2) was achieved in 41%. Elevated neuromarkers, older age and absence of ST-segment elevation after ROSC were associated with increased mortality. Poor neurological outcome in survivors was additionally associated with history of cerebrovascular events, sepsis and higher admission lactate. Mean NSE was 33μg/l [16–94] vs. 119μg/l [25–406]; p<0.001, for survivors vs. non-survivors, and 21μg/l [16–29] vs. 40μg/l [23–98], p<0.001 for good vs. poor neurological outcome. S-100b was 0.127μg/l [0.063–0.360] vs. 0.772μg/l [0.121–2.710], p<0.001 and 0.086μg/l [0.061–0.122] vs. 0.138μg/l [0.090–0.271], p = 0.009, respectively. For mortality, thresholds of 36μg/l for NSE and 0.128μg/l for S-100b could be determined; for poor neurological outcome 33μg/l (NSE) and 0.123μg/l (S-100b), respectively. Positive predictive value for NSE was 81% (74–88) and 79% (71–85) for S-100b. Conclusions Thresholds for NSE and S-100b predicting mortality and poor neurological outcome are similar in OHCA patients receiving therapeutic hypothermia as in those reported before the era of hypothermia. However, both biomarkers do not have enough specificity to predict mortality or poor neurological outcome on their own and should only be additively used in clinical decision making.

scholarly journals Post-resuscitation partial pressure of arterial carbon dioxide and outcome in patients with out-of-hospital cardiac arrest: a multicenter retrospective cohort study

2021 ◽  
Author(s):  
Nobunaga Okada ◽  
Tasuku Matsuyama ◽  
Yohei Okada ◽  
Asami Okada ◽  
Kenji Kandori ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Multivariate Logistic Regression Analysis ◽  
Spontaneous Circulation ◽  
Performance Category ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

Abstract We aimed to estimate the association between PaCO2 level in the patient after out-of-hospital cardiac arrest (OHCA) resuscitation with patient outcome based on a multicenter prospective cohort registry in Japan between June 2014 and December 2015.Based on the PaCO2 within 24-h after return of spontaneous circulation (ROSC), patients were divided into six groups as follow; severe hypocapnia (<25mmHg), mild hypocapnia (25–35mmHg,), normocapnia (35–45mmHg), mild hypercapnia (45–55mmHg), severe hypercapnia (>55mmHg), exposure to both hypocapnia and hypercapnia. Multivariate logistic regression analysis was conducted to calculate the adjusted odds ratios (aORs) and 95% confidence interval (CI) for the 1-month poor neurological outcome (Cerebral Performance Category ≥3). Among the 13491 OHCA patients, 607 were included. Severe hypocapnia, mild hypocapnia, severe hypercapnia, and exposure to both hypocapnia and hypercapnia were associated with a higher rate of 1-month poor neurological outcome compared with mild hypercapnia (aOR 6.68 [95% CI 2.16–20.67], 2.56 [1.30–5.04], 2.62 [1.06–6.47], 5.63 [2.21–14.34]; respectively). There was no significant difference between the outcome of patients with normocapnia and mild hypercapnia. In conclusion, maintaining normocapnia and mild hypercapnia during the 24-h after ROSC was associated with better neurological outcomes than other PaCO2 abnormalities in this study.

scholarly journals Prognostic Abilities of Serial Neuron-Specific Enolase and Lactate and their Combination in Cardiac Arrest Survivors During Targeted Temperature Management

2020 ◽  
Vol 9 (1) ◽  
pp. 159 ◽  
Author(s):  
Seung Mok Ryoo ◽  
Youn-Jung Kim ◽  
Chang Hwan Sohn ◽  
Shin Ahn ◽  
Dong Woo Seo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neuron Specific Enolase ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Prognostic Information ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome ◽  
Serial Serum ◽  
Lactate Levels ◽  
Hospital Cardiac Arrest

This study aimed to determine the prognostic ability of serial neuron-specific enolase (NSE) and lactate in cardiac arrest survivors treated with targeted temperature management (TTM) and to investigate whether a combination of NSE and lactate could increase prognostic information. This observational, retrospective, cohort study was conducted between January 2013 and December 2018; data were extracted from an out-of-hospital cardiac arrest registry. We collected serial serum NSE and lactate levels during TTM. The primary endpoint was poor neurological outcome at 28 days from cardiac arrest. Of all 160 included patients, 98 (61.3%) had poor neurological outcomes. Areas under the curves (AUCs) for NSE were 0.797, 0.871, and 0.843 at 24, 48, and 72 h, respectively (all p < 0.05). AUCs for lactate were 0.669, 0.578, 0.634, and 0.620 at 0, 24, 48, and 72 h, respectively (all p < 0.05). Although the combination of initial lactate and NSE at 48 h yielded the highest discovered AUC (0.877) it was not statistically different from that for the 48 h NSE alone (p = 0.692). During the TTM, NSE at 48 h from cardiac arrest was the most robust prognostic marker in comatose cardiac arrest survivors. However, a combination of the 48 h NSE with lactate did not increase the prognostic information.

Neuron-specific enolase and poor neurological outcome after sudden cardiac arrest: Looking for the best strategy

2019 ◽  
Vol 493 ◽  
pp. S615
Author(s):  
Á. García-Osuna ◽  
M. Canyelles-Vich ◽  
A. Antonijuan-Parés ◽  
V. Orantes-Gallego ◽  
M.N. Nan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Sudden Cardiac Arrest ◽  
Neuron Specific Enolase ◽  
Poor Neurological Outcome

scholarly journals Serum Neurofilament Measurement Improves Clinical Risk Score for Outcome Prediction After Cardiac Arrest: Results of A Prospective Study

2020 ◽  
Author(s):  
Sabina Hunziker ◽  
Adrian Quinto ◽  
Maja Ramin-Wright ◽  
Christoph Becker ◽  
Katharina Beck ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Single Molecule ◽  
Neurological Outcome ◽  
Outcome Prediction ◽  
Cerebral Performance Category ◽  
Neuron Specific Enolase ◽  
Risk Scores ◽  
Neurofilament Light Chain ◽  
Clinical Risk ◽  
Poor Neurological Outcome

Abstract Background: A recent study found serum neurofilament light chain (NfL) levels to be strongly associated with poor neurological outcome in patients after cardiac arrest. Our aim was to confirm these findings in an independent validation study and to investigate whether NfL improves the prognostic value of two cardiac arrest risk scores.Methods: This prospective, single-center study included 164 consecutive adult cardiac arrest patients upon intensive care unit admission. We calculated two clinical risk scores (OHCA, CAHP) and measured NfL on admission using the single molecule array NF-light® assay. The primary endpoint was neurological outcome at hospital discharge assessed with the cerebral performance category (CPC) score.Results: Poor neurological outcome (CPC≥3) was found in 60% (98/164) of patients, and 55% (91/164) died. Compared to patients with favorable outcome, NfL was 14-times higher in patients with poor neurological outcome (685±1787 vs. 49±111pg/mL), with an adjusted odds ratio of 3.4 (95%CI 2.1 to 5.6, p<0.001) and an area under the curve (AUC) of 0.82. Adding NfL to the clinical risk scores significantly improved discrimination of both the OHCA score (from AUC 0.82 to 0.89, p<0.001) and CAHP score (from AUC 0.89 to 0.92, p<0.05). Admission NfL showed better outcome prediction compared to neuron-specific enolase (NSE) (AUC 0.84 vs.0.69, p=0.01).Conclusions: This study confirms the high performance of admission NfL alone and in combination with two clinical risk scores to prognosticate clinical outcome in patients after cardiac arrest. NfL should be considered as a standard laboratory measures in the evaluation of cardiac arrest patients.

scholarly journals Prognostic Value of Early Intermittent Electroencephalography in Patients After Extracorporeal Cardiopulmonary Resuscitation

2020 ◽  
Author(s):  
Yong Oh Kim ◽  
Ryoung-Eun Ko ◽  
Chi Ryang Chung ◽  
Jeong Hoon Yang ◽  
Taek Kyu Park ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Neurological Status ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome ◽  
Neurological Prognosis ◽  
Favorable Neurological Outcome

Abstract Background The aim of this study was to investigate whether intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Methods This was a retrospective, single center, and observational study of adult patients who were evaluated by EEG scan within 96 hours after ECPR between February 2012 and December 2018. The primary endpoint was neurological status upon discharge from the hospital assessed with Cerebral Performance Categories (CPC) scale. Results Among 69 adult cardiac arrest patients who underwent ECPR, 32 (46.4%) patients survived until discharge from the hospital. Of these 32 survivors, 17 (24.6%) patients had favorable neurological outcomes (CPC score: 1 or 2). Sedatives or analgesics were used in 41 (59.4%) patients. Malignant EEG patterns were more common in patients with poor neurological outcome than in patients with favorable neurological outcome (73.1% vs. 5.9%, p < 0.001). All patients with highly malignant EEG patterns (43.5%) had poor neurological outcome. Moderately malignant EEG patterns were reported in 8 (11.6%) patients with poor neurological outcome and one (1.4%) patient with favorable neurological outcome. Benign EEG patterns were more common in patients with favorable neurological outcome than in patients with poor neurological outcome (94.1% vs. 26.9%, p < 0.001). In multivariable analysis, malignant EEG patterns (adjusted odd ratio [OR]: 53.26, 95% confidence interval [CI]: 5.956 – 476.249) and duration of cardiopulmonary resuscitation (adjusted OR: 1.07, 95% CI: 1.011 – 1.130) were significantly associated with poor neurological outcomes in patients who underwent ECPR (Hosmer-Lemeshow Chi-squared = 7.84, df = 7, p = 0.347). Conclusions In this study, malignant EEG patterns within 96 hr after cardiac arrest were significantly associated with poor neurological outcomes in patients who underwent ECPR. Therefore, early intermittent EEG scan could be helpful for predicting neurological prognosis of post-cardiac arrest patients after ECPR.

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