Prediction of neurological outcome after cardiopulmonary resuscitation by serial determination of serum neuron-specific enolase.
OBJECTIVE
Data on the diagnostic accuracy of neuron-specific enolase (NSE) as marker of hypoxic brain damage are conflicting. The purpose of this prospective observational cohort study was to explore the prognostic value of serum NSE after cardiopulmonary resuscitation (CPR) and to define the most sensitive cutoff value with a specificity of 100% for the prediction of persistent coma.


RESULTS
Serum NSE concentrations were serially determined in 227 consecutive unconscious patients after CPR who were classified according to the best Glasgow-Pittsburgh cerebral performance categories (CPC, 1-4) achieved within 6 months follow-up. Sixteen patients were excluded due to incomplete NSE data and 34 due to death under analgesia sedation. The prevalence of poor neurological outcome (persistent coma, CPC 4) in our 177 analysed patients was 33%. At a specificity of 100%, a peak NSE concentration above 80 ng/mL predicted persistent coma with a sensitivity of 63%, a positive predictive value of 100%, a negative predictive value of 84%, and a predictive accuracy of 88%.


CONCLUSIONS
A peak serum NSE concentration exceeding 80 ng/mL is a highly specific but only moderately sensitive marker for a poor neurological outcome after CPR.
Reisinger
Johann
J
Department of Internal Medicine/Cardiology, Krankenhaus Barmherzige Schwestern, Seilerstätte 4, 4010 Linz, Austria. johann.reisinger@bhs.at
Höllinger
Kurt
K
Lang
Wolfgang
W
Steiner
Christoph
C
Winter
Thomas
T
Zeindlhofer
Eduard
E
Mori
Michael
M
Schiller
Alexandra
A
Lindorfer
Alexander
A
Wiesinger
Kurt
K
Siostrzonek
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000201:enzymology / Q000628:therapy*; D006801:Humans; D002534:Hypoxia, Brain / Q000201:enzymology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000378:metabolism*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D010751:Phosphopyruvate Hydratase