Neuron-specific enolase kinetics: an additional tool for neurological prognostication after cardiac arrest

Martínez-Losas, Pedro; Sá, Esteban López de; Armada, Eduardo; Rosillo, Sandra; Monedero, María Carmen; Rey, J.; Caro‐Codón, Juan; Soto, Antonio Buño; Sendón, José Luis López

doi:10.1016/j.rec.2019.01.008

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…120 Another recent report revealed that the elevation of NSE between hospital admission and 72 hours after ROSC was not only associated with poor neurological outcome, with an AUC of 0.90 (95%CI, 0.85-0.95), but was also an independent predictor of poor outcome in a multivariate analysis (P < .001). 121 Present data suggest that NFL is a promising neural marker and warrants further study and that NSE is the most generally supported biomarker in predicting outcome to date. Clinicians shall take other prognostic assessments into account when interpreting biomarker results, which require further standardization and validation in large prospective cohorts.…”

Section: Biomarkersmentioning

confidence: 66%

Targeted temperature management and early neuro-prognostication after cardiac arrest

Chen

Lachance

Gao

et al. 2021

J Cereb Blood Flow Metab

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Targeted temperature management (TTM) is a recommended neuroprotective intervention for coma after out-of-hospital cardiac arrest (OHCA). However, controversies exist concerning the proper implementation and overall efficacy of post-CA TTM, particularly related to optimal timing and depth of TTM and cooling methods. A review of the literature finds that optimizing and individualizing TTM remains an open question requiring further clinical investigation. This paper will summarize the preclinical and clinical trial data to-date, current recommendations, and future directions of this therapy, including new cooling methods under investigation. For now, early induction, maintenance for at least 24 hours, and slow rewarming utilizing endovascular methods may be preferred. Moreover, timely and accurate neuro-prognostication is valuable for guiding ethical and cost-effective management of post-CA coma. Current evidence for early neuro-prognostication after TTM suggests that a combination of initial prediction models, biomarkers, neuroimaging, and electrophysiological methods is the optimal strategy in predicting neurological functional outcomes.

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Section: Biomarkersmentioning

confidence: 66%

Targeted temperature management and early neuro-prognostication after cardiac arrest

Chen

Lachance

Gao

et al. 2021

J Cereb Blood Flow Metab

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“…For example, one recent study reported that a 48 h NSE was a better predictor than the NSE measured at 24 or 72 h-the corresponding AUC values were 0.87, 0.78, and 0.80, and the optimal cut-off values were 70.0, 68.1, and 56.0 µg/L [21]. Conversely, another retrospective study reported that the AUC for 72 h NSE (0.88) was a better predictor than the AUCs at 24 h (0.73) and 48 h (0.85) [8].…”

Section: Resultsmentioning

confidence: 91%

“…Current international guidelines recommend using NSE to assess neurological outcomes [5,6], as NSE is a marker of ischemic brain injury [7]. NSE is found in neuronal and neuroendocrine cells, and serum NSE concentrations correlate positively with the extent of anoxic-ischemic neurological injury and with malignant electroencephalography changes, after cardiac arrest [8][9][10]. Before the advent of TTM, a prospective study reported that a serum NSE concentration > 33 µg/L on days 1-3 after cardiac arrest was strongly associated with poor neurological outcome (false positive rate [FPR] 0%) [11].…”

Section: Introductionmentioning

confidence: 99%

“…Before the advent of TTM, a prospective study reported that a serum NSE concentration > 33 µg/L on days 1-3 after cardiac arrest was strongly associated with poor neurological outcome (false positive rate [FPR] 0%) [11]. However, results were more variable in subsequent studies, with unacceptably high FPRs being repeatedly reported [8]. Moreover, with TTM, the reliability of an NSE cut-off is unknown.…”

Section: Introductionmentioning

confidence: 99%

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

Ryoo

Sohn

Kim

et al. 2020

JCM

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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.

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“…Martínez-Losas et al 16 Meta-analysis eTable 1 (links.lww.com/WNL/B622) shows contingency tables for all thresholds extracted from the included studies. Data points from virtually all studies, except one, 19 were of low or very low quality.…”

Section: Risk Of Biasmentioning

confidence: 99%

Serum Neuron-Specific Enolase Thresholds for Predicting Postcardiac Arrest Outcome

et al. 2022

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Background and ObjectivesTo determine thresholds of serum neuron-specific enolase (NSE) for prediction of poor outcome after cardiac arrest with >95% specificity using a unique method of multiple thresholds meta-analysis.MethodsData from a systematic review by the European Resuscitation Council (ERC 2014) were updated with literature searches from PubMed, Cochrane, and Scopus until August 2020. Search terms included the MeSH terms “heart arrest” and “biomarkers” and the text words “cardiac arrest,” “neuron specific enolase,” “coma” and “prognosis.” Cohort studies with comatose cardiac arrest survivors aged >16 years undergoing targeted temperature management (TTM) and NSE levels within 96 hours of resuscitation were included. Poor outcome was defined as cerebral performance category 3–5 at hospital discharge or later. Studies without extractable contingency tables were excluded. A multiple thresholds meta-analysis model was used to generate summary receiver operating characteristic curves for various time points. NSE thresholds (and 95% prediction intervals) for >95% specificity were calculated. Evidence appraisal was performed using a method adapted from the American Academy of Neurology grading criteria.ResultsData from 11 studies (n = 1,982) at 0–24 hours, 21 studies (n = 2,815) at 24–48 hours, and 13 studies (n = 2,557) at 48–72 hours was analyzed. Areas under the curve for prediction of poor outcomes were significantly larger at 24–48 hours and 48–72 hours compared to 0–24 hours (0.82 and 0.83 vs 0.64). Quality of evidence was very low for most studies because of the risk of incorporation bias—knowledge of NSE levels potentially influenced life support withdrawal decisions. To minimize falsely pessimistic predictions, NSE thresholds at the upper 95% limit of prediction intervals are reported. For prediction of poor outcome with specificity >95%, upper limits of the prediction interval for NSE were 70.4 ng/mL at 24–48 hours and 58.6 ng/mL at 48–72 hours. Sensitivity analyses excluding studies with inconsistent TTM use or different outcome criteria did not substantially alter the results.ConclusionsNSE thresholds for highly specific prediction of poor outcome are much higher than generally used. Future studies must minimize bias by masking treatment teams to the results of potential predictors and by prespecifying criteria for withdrawal of life support.

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Neuron-specific enolase kinetics: an additional tool for neurological prognostication after cardiac arrest

Cited by 7 publications

References 22 publications

Targeted temperature management and early neuro-prognostication after cardiac arrest

Targeted temperature management and early neuro-prognostication after cardiac arrest

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

Serum Neuron-Specific Enolase Thresholds for Predicting Postcardiac Arrest Outcome

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