The usefulness of neuron-specific enolase in cerebrospinal fluid to predict neurological prognosis in cardiac arrest survivors who underwent target temperature management: A prospective observational study

You, Yeonho; Park, Jung Soo; Min, Jin Hong; Yoo, In Seol; Ahn, Hong Joon; Cho, Yong Chul; Ryu, Seung Ho; Lee, Jinwoong; SeungWhan, Kim; Cho, Sunguk; Oh, Suyeon; Jeong, Wonjoon; Kang, Changshin; Oh, Eungseok; Lee, Byung Kook; Lee, Donghun; Youn, Chun Song

doi:10.1016/j.resuscitation.2019.09.027

Cited by 20 publications

(21 citation statements)

References 34 publications

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“…Moreover, this method has low sensitivity, and drawbacks of significant deviation depending on the interpreter [8]. However, MRI has been shown to predict hypoxic-ischemic brain injury (HIBI), proving that its CA prediction ability of comatose survivors after ROSC is superior to that of CT [8,10,15]. Cortical laminar necrosis of the brain may be identified within hours of the anoxic-ischemic event, and MR-DWI offers good visualization of laminar necrosis and other characteristic signs of hypoxic injury with unsurpassed promptness [15].…”

Section: Discussionmentioning

confidence: 99%

“…A decrease in ADC values may serve as an indication that the affected areas of the brain will die [17]. The severity of CytE represented by lowered ADC values can be measured quantitatively [10,17].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, brain damage in patients with CA can be identified earlier using MRI compared to using CT. Jeon et al reported that the AUC and sensitivity for predicting poor neurologic outcomes in the presence of abnormal HSI in DWI immediately after ROSC (DWI was performed in 175 min (range 117-240] of median time after ROSC) were 0.894 (95% CI 0.753-0.969) and 78.8% (95% CI 61.1-91.0) with 100% specificity, respectively [8]. The quantitative method involves restricted diffusion using cytotoxic edema, which is quantified by calculating the ADC value of each voxel [10,21]. Moon et al reported that the AUC and sensitivity for poor neurologic outcome prediction of voxels with ADC values under 400 × 10 −6 mm 2 /s in MR-DWI performed within 48 h after CA were 0.891 (95% CI 0.792-0.989) and 64.0% (95% CI 42.5-82.0) with 100% specificity, respectively [10].…”

Section: Discussionmentioning

confidence: 99%

“…Voxels with ADC values above 1590 × 10 −6 mm 2 /s were extracted from the analysis to exclude artefacts or pure CSF. Previous studies have used the percentage of voxels (PV) below different ADC thresholds and reported that the PV 400 (percentage of voxels below 400 × 10 −6 mm 2 /s) showed the highest odds ratio value when predicting the poor prognosis of a patient; therefore, we also used the PV 400 [10].…”

Section: Mri (High Signal Intensity In Dwi and Percentage Of Voxels Omentioning

confidence: 99%

“…We previously reported that neuron-specific enolase in cerebrospinal fluid (CSF NSE) predicts the prognosis of patients with CA [10] and we reported that results of brain computed tomography (CT) and magnetic resonance imaging (MRI) prior to TTM can be used to predict prognosis in CA survivors [8]. In this study, we hypothesized that combining the NSE level and brain images of CA survivors who had undergone TTM immediately after ROSC may have better prognostic performance than any single analysis.…”

Section: Introductionmentioning

confidence: 99%

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Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Son

Park

Yoo

et al. 2020

JCM

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We examined whether combining biomarkers measurements and brain images early after the return of spontaneous circulation improves prognostic performance compared with the use of either biomarkers or brain images for patients with cardiac arrest following target temperature management (TTM). This retrospective observational study involved comatose out-of-hospital cardiac arrest survivors. We analyzed neuron-specific enolase levels in serum (NSE) or cerebrospinal fluid (CSF), grey-to-white matter ratio by brain computed tomography, presence of high signal intensity (HSI) in diffusion-weighted imaging (DWI), and voxel-based apparent diffusion coefficient (ADC). Of the 58 patients, 33 (56.9%) had poor neurologic outcomes. CSF NSE levels showed better prognostic performance (area under the curve (AUC) 0.873, 95% confidence interval (CI) 0.749–0.950) than serum NSE levels (AUC 0.792, 95% CI 0.644–0.888). HSI in DWI showed the best prognostic performance (AUC 0.833, 95% CI 0.711–0.919). Combining CSF NSE levels and HSI in DWI had better prognostic performance (AUC 0.925, 95% CI 0.813–0.981) than each individual method, followed by the combination of serum NSE levels and HSI on DWI and that of CSF NSE levels and the percentage of voxels of ADC (AUC 0.901, 95% CI 0.792–0.965; AUC 0.849, 95% CI 0.717–0.935, respectively). Combining CSF/serum NSE levels and HSI in DWI before TTM improved the prognostic performance compared to either each individual method or other combinations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Mri (High Signal Intensity In Dwi and Percentage Of Voxels Omentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Son

Park

Yoo

et al. 2020

JCM

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Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

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Cerebrospinal Fluid Lactate Levels, Brain Lactate Metabolism and Neurologic Outcome in Patients with Out-of-Hospital Cardiac Arrest

Son

In²,

Park

et al. 2021

Neurocrit Care

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The usefulness of neuron-specific enolase in cerebrospinal fluid to predict neurological prognosis in cardiac arrest survivors who underwent target temperature management: A prospective observational study

Cited by 20 publications

References 34 publications

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Cerebrospinal Fluid Lactate Levels, Brain Lactate Metabolism and Neurologic Outcome in Patients with Out-of-Hospital Cardiac Arrest

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