Usefulness of neuron specific enolase in prognostication after cardiac arrest: Impact of age and time to ROSC

Abstract

Aim of the study: We evaluated the impact of patient age and time from collapse to return of spontaneous circulation (ROSC) on the prognostic accuracy of neuron specific enolase (NSE) after out-of-hospital cardiac arrest (OHCA). Methods: Using electrochemiluminescence immunoassay, we measured serum concentrations of NSE in 249 patients who were admitted to intensive care units after resuscitation from OHCA. In each quartile according to age and time to ROSC, we evaluated the ability of NSE at 48 h after OHCA to predict poor outcome (Cerebral Performance Category 3-5) at 12 months. Results: The outcome at 12 months was poor in 121 (49%) patients. The prognostic performance of NSE was excellent (area under the receiver operating characteristic curve, AUROC, 0.91 [95% confidence interval, 0.81-1.00]) in the youngest quartile (18-56 years), but worsened with increasing age, and was poor (AUROC 0.53 [0.37-0.70]) in the oldest quartile (72 years or more). The prognostic performance of NSE was worthless (AUROC 0.45 [0.30-0.61]) in the quartile with the shortest time to ROSC (1-13 min), but improved with increasing time to ROSC, and was good (AUROC 0.84 [0.74-0.95]) in the quartile with the longest time to ROSC (29 min or over). Conclusion: NSE at 48 h after OHCA is a useful predictor of 12-month-prognosis in young patients and in patients with a long time from collapse to ROSC, but not in old patients or patients with a short time to ROSC.

The Predictive Role of QEEG in the Post-Operative Delirium and Prognosis of Cardiac Surgery Patients

“…Certain studies indicated that Hs-CRP and IL-6 may have the potential to predict the onset of delirium [21,22], whereas we did not find the correlation ship between Hs-CRP or IL-6 with delirium. In addition, our results did not show the significant different of NSE, a specific biomarker of neurons impairments [23], between the two groups. So, the predictive roles of these biomarkers in occurring of delirium need to be future studied.…”

European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care

“…375 In a recent study, the prognostic performance of NSE was clearly dependent on age and severity of the insult (time to ROSC). 380 It performed best in the youngest quartile and in patients with longer time to ROSC. Several different analytical assays were used in the included studies but the methodology for routine clinical use provided by Roche and Brahms were most frequent.…”

Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial

“…NSE concentration at 48-72 h after CA has demonstrated moderate accuracy with areas under the receiver operating characteristic curves (AUROC) between 0.85 and 0.90 in predicting neurological outcome, but optimal cutoff values vary widely between studies [9][10][11][12]. Unfortunately, NSE is sensitive to blood sample haemolysis [13] and its prognostic ability is reduced in the elderly and in patients with shorter CA duration [14]. Therefore, novel biomarkers with superior performance to predict neurological outcome after OHCA are urgently needed to guide clinical management of this group of patients.…”