Neuron-specific enolase and neuroimaging for prognostication after cardiac arrest treated with targeted temperature management

Abstract

Background Prognostication after cardiac arrest (CA) needs a multimodal approach, but the optimal method is not known. We tested the hypothesis that the combination of neuron-specific enolase (NSE) and neuroimaging could improve outcome prediction after CA treated with targeted temperature management (TTM). Methods A retrospective observational cohort study was performed on patients who underwent at least one NSE measurement between 48 and 72 hr; received both a brain computed tomography (CT) scan within 24 hr and diffusion-weighted magnetic resonance imaging (DW-MRI) within 7 days after return of spontaneous circulation (ROSC); and were treated with TTM after out-of-hospital CA between 2009 and 2017 at the Seoul St. Mary's Hospital in Korea. The primary outcome was a poor neurological outcome at 6 months after CA, defined as a cerebral performance category of 3-5. Results A total of 109 subjects underwent all three tests and were ultimately included in this study. Thirty-four subjects (31.2%) experienced good neurological outcomes at 6 months after CA. The gray matter to white matter attenuation ratio (GWR) was weakly correlated with the mean apparent diffusion coefficient (ADC), PV400 and NSE (Spearman's rho: 0.359,-0.362 and-0.263, respectively). NSE was strongly correlated with the mean ADC and PV400 (Spearman's rho:-0.623 and 0.666, respectively). Serum NSE had the highest predictive value among the single parameters (area under the curve (AUC) 0.912, sensitivity 70.7% for maintaining 100% specificity). The combination of a DWI parameter (mean ADC or PV400)

Neuron-Specific Enolase—What Are We Measuring?

“…Serum NSE levels are higher in patients with ischemic stroke than in healthy controls and correlate with infarct size and neurological deficits [17,18]. Several studies have demonstrated the prognostic significance of serum NSE concentrations in ischemic [17,[19][20][21][22][23] and hemorrhagic stroke [24], hypertension [25,26], ischemia-reperfusion brain injury [27], and out-of-hospital cardiac arrest [28][29][30][31]. Based on these findings, the American Academy of Neurology recommended the use of serum NSE to predict adverse outcomes after global cerebral hypoperfusion in patients requiring cardiopulmonary resuscitation [32].…”