Kieran Gillick1, Kieron Rooney2. 1. Bristol Royal Infirmary, Bristol, UK. 2. Bristol Royal Infirmary, Bristol, UK. Electronic address: kieron.rooney@UHBristol.nhs.uk.
Abstract
AIMS: Prognostication following out-of-hospital cardiac arrest (OHCA) remains challenging. A multimodal approach is favoured, including consideration of the biomarker neuron-specific enolase (NSE) (Sandroni et al., 2014). Our objective was to investigate the utility of serial NSE measurements and to determine an appropriate cut-off value for prediction of death before hospital discharge using data from our tertiary care center. METHODS: Retrospective analysis of patients admitted to the critical care unit of a tertiary center critical care unit in the UK following an out-of-hospital cardiac arrest. MEASUREMENTS AND MAIN RESULTS: We analysed data from 72 patients admitted to our unit over 8 months following out-of-hospital cardiac arrest. Initial NSE level (NSE0) was a poor predictor of outcome. Both NSE level at 48 h post-admission (NSE48) and change in NSE from baseline to 48 h post-admission (ΔNSE) were good predictors of outcome. A cut-off of NSE48 > 69.8 ng/ml gave a specificity of 1.00 and sensitivity of 0.62 for prediction of death before hospital discharge in our patient group, whilst a cut-off of ΔNSE > 31.3 ng/ml gave a specificity of 1.00 and sensitivity of 0.54. In patients who did not survive to hospital discharge, ΔNSE > 9.4 ng/ml was associated with other poor prognostic factors (asytolic/PEA arrest, long downtime before ROSC) and with more rapid deterioration before death. CONCLUSION: Serial measurement of NSE levels (at 0 and 48 h after admission) provides a useful tool to aid prognostication following out-of-hospital cardiac arrest.
AIMS: Prognostication following out-of-hospital cardiac arrest (OHCA) remains challenging. A multimodal approach is favoured, including consideration of the biomarker neuron-specific enolase (NSE) (Sandroni et al., 2014). Our objective was to investigate the utility of serial NSE measurements and to determine an appropriate cut-off value for prediction of death before hospital discharge using data from our tertiary care center. METHODS: Retrospective analysis of patients admitted to the critical care unit of a tertiary center critical care unit in the UK following an out-of-hospital cardiac arrest. MEASUREMENTS AND MAIN RESULTS: We analysed data from 72 patients admitted to our unit over 8 months following out-of-hospital cardiac arrest. Initial NSE level (NSE0) was a poor predictor of outcome. Both NSE level at 48 h post-admission (NSE48) and change in NSE from baseline to 48 h post-admission (ΔNSE) were good predictors of outcome. A cut-off of NSE48 > 69.8 ng/ml gave a specificity of 1.00 and sensitivity of 0.62 for prediction of death before hospital discharge in our patient group, whilst a cut-off of ΔNSE > 31.3 ng/ml gave a specificity of 1.00 and sensitivity of 0.54. In patients who did not survive to hospital discharge, ΔNSE > 9.4 ng/ml was associated with other poor prognostic factors (asytolic/PEA arrest, long downtime before ROSC) and with more rapid deterioration before death. CONCLUSION: Serial measurement of NSE levels (at 0 and 48 h after admission) provides a useful tool to aid prognostication following out-of-hospital cardiac arrest.
Authors: Karl W Huesgen; Yasmeen O Elmelige; Zhihui Yang; Muhammad Abdul Baker Chowdhury; Sarah Gul; Carolina B Maciel; Marie-Carmelle Elie-Turenne; Torben K Becker; Scott A Cohen; Amy Holland; Cindy Montero; Tian Zhu; Kevin K Wang; Joseph A Tyndall Journal: Resusc Plus Date: 2021-06-08