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

作者：Stammet, Pascal^*; Collignon, Olivier; Hassager, Christian; Wise, Matthew P.; Hovdenes, Jan; Aneman, Anders; Horn, Janneke; Devaux, Yvan; Erlinge, David; Kjaergaard, Jesper; Gasche, Yvan; Wanscher, Michael; Cronberg, Tobias; Friberg, Hans; Wetterslev, Jorn; Pellis, Tommaso; Kuiper, Michael; Gilson, Georges; Nielsen, Niklas

来源：Journal of the American College of Cardiology, 2015, 65(19): 2104-2114.

DOI：10.1016/j.jacc.2015.03.538

• biomarker
• cerebral performance
• neuroprognostication
• prognosis

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 degrees C or 36 degrees 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 degrees C or 36 degrees C does not significantly affect NSE levels.

• 出版日期2015-5-19