Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study.
OBJECTIVE
The aim of this study was to investigate whether serial serum neuron-specific enolase (NSE) can be used to predict neurological prognosis in patients remaining comatose after cardiopulmonary resuscitation (CPR). DESIGN. Observational cohort study. Clinicians were blinded to NSE results.


METHODS
Eighteen-bed general ICU.


METHODS
Comatose patients admitted to the ICU after CPR.


METHODS
Serum NSE was measured at admission and daily for 5 days.


RESULTS
Patients received full intensive treatment until recovery or until absence of cortical response to somatosensory evoked potentials more than 48 h after CPR proved irreversible coma. Of the 110 patients included (mean GCS at ICU admission 3, range 3--9), 34 regained consciousness, five of whom died in hospital. Seventy-six patients did not regain consciousness, 72 of whom died in hospital. Serum NSE at 24 h and at 48 h after CPR was significantly higher in patients who did not regain consciousness than in patients who regained consciousness (at 24 h: median NSE 29.9 microg/l, range 1.8-250 vs 9.9 microg/l, range 4.5-21.5, P<0.001; at 48 h: median 37.8 microg/l, range 4.4-411 vs 9.5 microg/l, range 6.2-22.4, P= 0.001). No patient with a serum NSE level >25.0 microg/l at any time regained consciousness. Addition of NSE to GCS and somatosensory evoked potentials increased predictability of poor neurological outcome from 64% to 76%.


CONCLUSIONS
High serum NSE levels in comatose patients at 24 h and 48 h after CPR predict a poor neurological outcome. Addition of NSE to GCS and somatosensory evoked potentials increases predictability of neurological outcome.
Meynaar
Iwan A
IA
Intensive Care Unit, Reinier de Graaf Gasthuis, Reinier de Graafweg 3-11, 2625 AD, Delft, Netherlands. meynaar@rdgg.nl
Oudemans-van Straaten
Heleen M
HM
van der Wetering
Jacobus
J
Verlooy
Peter
P
Slaats
Ed H
EH
Bosman
Rob J
RJ
van der Spoel
Johan I
JI
Zandstra
Durk F
DF
D000368:Aged; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D015331:Cohort Studies; D003128:Coma / Q000201:enzymology* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D003243:Consciousness; D003422:Critical Care / Q000379:methods; D005073:Evoked Potentials, Somatosensory; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D002534:Hypoxia, Brain / Q000201:enzymology* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D010751:Phosphopyruvate Hydratase