title: Mild therapeutic hypothermia alters neuron specific enolase as an outcome predictor after resuscitation: 97 prospective hypothermia patients compared to 133 historical non-hypothermia patients.
abstract: BACKGROUND
  Neuron specific enolase (NSE) has been proven effective in predicting neurological outcome after cardiac arrest with a current cut off recommendation of 33 microg/l. However, most of the corresponding studies were conducted before the introduction of mild therapeutic hypothermia (MTH). Therefore we conducted a study investigating the association between NSE and neurological outcome in patients treated with MTH.
  
  
  METHODS
  In this prospective observational cohort study the data of patients after cardiac arrest receiving MTH (n = 97) were consecutively collected and compared with a retrospective non-hypothermia (NH) group (n = 133). Serum NSE was measured 72 hours after admission to ICU. Neurological outcome was classified according to the Pittsburgh cerebral performance category (CPC 1 to 5) at ICU discharge.
  
  
  RESULTS
  NSE serum levels were significantly lower under MTH compared to NH in univariate analysis. However, in a linear regression model NSE was affected significantly by time to return of spontaneous circulation (ROSC) and ventricular fibrillation rhythm but not by MTH. The model for neurological outcome identified NSE, NSE*MTH (interaction) as well as time to ROSC as significant predictors. Receiver Operating Characteristic (ROC) analysis revealed a higher cutoff value for unfavourable outcome (CPC 3 to 5) with a specificity of 100% in the hypothermia group (78.9 microg/l) compared to the NH group (26.9 microg/l).
  
  
  CONCLUSIONS
  Recommended cutoff levels for NSE 72 hours after ROSC do not reliably predict poor neurological outcome in cardiac arrest patients treated with MTH. Prospective multicentre trials are required to re-evaluate NSE cutoff values for the prediction of neurological outcome in patients treated with MTH.
authors.affiliation: Department of Nephrology and Medical Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, Berlin, Germany. ingo.steffen@charite.de
authors.forename: Ingo G
authors.initials: IG
authors.lastname: Steffen
authors.forename: Dietrich
authors.initials: D
authors.lastname: Hasper
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Ploner
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Schefold
authors.forename: Ekkehart
authors.initials: E
authors.lastname: Dietz
authors.forename: Frank
authors.initials: F
authors.lastname: Martens
authors.forename: Jens
authors.initials: J
authors.lastname: Nee
authors.forename: Anne
authors.initials: A
authors.lastname: Krueger
authors.forename: Achim
authors.initials: A
authors.lastname: Jörres
authors.forename: Christian
authors.initials: C
authors.lastname: Storm
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000150:complications / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D012151:Resuscitation
chemical_list: D010751:Phosphopyruvate Hydratase
references.citation: Resuscitation. 2009 Jul;80(7):784-9
references.pmid: 19467754
references.citation: Lancet. 1975 Mar 1;1(7905):480-4
references.pmid: 46957
references.citation: Crit Care Med. 1997 Jul;25(7):1133-8
references.pmid: 9233737
references.citation: Stroke. 1999 Aug;30(8):1598-603
references.pmid: 10436107
references.citation: Neurology. 2006 Jul 25;67(2):203-10
references.pmid: 16864809
references.citation: Stroke. 2003 Dec;34(12):2881-6
references.pmid: 14631087
references.citation: Eur Heart J. 2007 Jan;28(1):52-8
references.pmid: 17060343
references.citation: Resuscitation. 2009 Oct;80(10):1119-23
references.pmid: 19631442
references.citation: Neurology. 2006 Jan 10;66(1):62-8
references.pmid: 16401847
references.citation: Resuscitation. 2009 Feb;80(2):165-70
references.pmid: 18954930
references.citation: Neurology. 1999 Mar 10;52(4):746-9
references.pmid: 10078721
references.citation: Resuscitation. 2001 May;49(2):183-91
references.pmid: 11382525
references.citation: Intensive Care Med. 2003 Feb;29(2):189-95
references.pmid: 12594583
references.citation: Crit Care Med. 2007 Apr;35(4):1041-7
references.pmid: 17334257
references.citation: Resuscitation. 2005 Apr;65(1):49-55
references.pmid: 15797275
references.citation: Acta Anaesthesiol Scand. 2009 Aug;53(7):926-34
references.pmid: 19549271
references.citation: Resuscitation. 2009 Jun;80(6):658-61
references.pmid: 19362767
references.citation: Resuscitation. 2006 Apr;69(1):29-32
references.pmid: 16517042
references.citation: Crit Care. 2008;12(3):R78
references.pmid: 18554414
references.citation: Scand J Trauma Resusc Emerg Med. 2008 Sep 15;16:9
references.pmid: 18957071
references.citation: J Neurol Neurosurg Psychiatry. 1996 Dec;61(6):610-5
references.pmid: 8971110
references.citation: Neurocrit Care. 2009 Dec;11(3):338-44
references.pmid: 19588273
references.citation: Clin Neurol Neurosurg. 2006 Sep;108(6):558-63
references.pmid: 16457947