Neuron-Specific Enolase (NSE) Predicts Long-Term Mortality in Adult Patients after Cardiac Arrest: Results from a Prospective Trial

Background: We investigated whether Neuron-specific enolase (NSE) serum concentration predicts long-term mortality and poor neurological outcome in adult cardiac arrest patients. Methods: Within this prospective observational study, we included consecutive adult patients admitted to the intensive care unit (ICU) after cardiac arrest. NSE was measured upon ICU admission and on days 1, 2, 3, 5 and 7. Results: Of 403 patients, 176 (43.7%) survived. Median follow-up duration was 43.7 months (IQR 14.3 to 63.0 months). NSE levels on day 3 were increased more than threefold in non-survivors compared to survivors (median NSE (ng/mL) 19.8 (IQR 15.7 to 27.8) vs. 72.6 (IQR 26 to 194)) and showed the highest prognostic performance for mortality compared to other days of measurement, with an AUC of 0.81 and an adjusted hazard ratio of 1.55 (95% CI 1.41 to 1.71, p < 0.001). Subgroup analysis showed an excellent sensitivity and negative predictive value of 100% of NSE in patients <54 years of age. Conclusion: NSE measured three days after cardiac arrest is associated with long-term mortality and neurological outcome and may provide prognostic information that improves clinical decision making. Particularly in the subgroup of younger patients (<54 years), NSE showed excellent negative predictive value.

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

PLoS ONE ◽

10.1371/journal.pone.0245210 ◽

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.

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High specificity and negative predictive value of exercise testing for long-term mortality in asymptomatic men

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)80603-9 ◽

2002 ◽

Vol 39 ◽

pp. 137

Author(s):

Samia Mora ◽

Yadong Cui ◽

Maura K. Whiteman ◽

Jodi A. Flaws ◽

Roger S. Blumenthal

Keyword(s):

Negative Predictive Value ◽

Exercise Testing ◽

Predictive Value ◽

High Specificity ◽

Asymptomatic Men ◽

Long Term Mortality

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Predictive value of hospital discharge neurological outcome scores for long-term neurological status following out-of-hospital cardiac arrest: A systematic review

Resuscitation ◽

10.1016/j.resuscitation.2020.04.013 ◽

2020 ◽

Vol 151 ◽

pp. 139-144

Author(s):

Wen Wu ◽

Amit Chopra ◽

Carolyn Ziegler ◽

Shelley L. McLeod ◽

Steve Lin

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Predictive Value ◽

Neurological Outcome ◽

Neurological Status ◽

Outcome Scores ◽

Hospital Cardiac Arrest

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Abstract 12875: Serum Neutrophil Gelatinase-associated Lipocalin Has a Predictive Value for the Neurological Outcome of Post Cardiac Arrest Victims

Circulation ◽

10.1161/circ.132.suppl_3.12875 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Tadashi Kaneko ◽

Motoki Fujita ◽

Yasuaki Ogino ◽

Hiroki Irie ◽

Shinsuke Iwashita ◽

...

Keyword(s):

Cardiac Arrest ◽

Roc Curve ◽

Predictive Value ◽

Neurological Outcome ◽

Neuron Specific Enolase ◽

Area Under The Curve ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Significant Difference ◽

Neutrophil Gelatinase

Introduction: Neutrophil gelatinase-associated lopocalin (NGAL) is well known as the biomarker of acute kidney injury. Currently, serum NGAL is reported as the biomarker which is associated with mortality and multiple organ dysfunction syndrome in septic patients. In this study, we measured serum NGAL in post cardiac arrest syndrome (PCAS) patients to investigate the predictive value of neurological outcome. Hypothesis: Serum NGAL is associated with favorable neurological outcome of PCAS patients. Methods: 43 cases of PCAS patients were measured serum NGAL on day 1 and 2, and serum neuron specific enolase (NSE) was also measured on day 2. Patients were divided into two group (group G: CPC 1-2 and group P: CPC 3-5, CPC: cerebral performance categories). Serum NGAL and NSE were compared between group G and P. Receiver operation characteristic (ROC) curve analysis were performed of both NGAL and NSE. Results: Group G (n = 20) and P (n = 23) were analyzed. Serum NGAL showed significant difference in day 2 (G: 282±116 ng/mL v.s. P: 299±87 ng/mL in day1: P = 0.609, G: 185±124 ng/mL v.s. P: 353±110 ng/mL in day 2: P<0.001). The ROC curve analysis showed area under the curve of NGAL in day 2 was 0.871, and the area of NSE in day2 showed 0.918. Conclusions: Serum NGAL in PCAS patients had the predictive value for neurological outcome which is comparable to serum NSE. (This study was supported by grants from Japanese Ministry of Health, Labour and Welfare: No. 25462824)

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