title: Serial measurement of neuron specific enolase improves prognostication in cardiac arrest patients treated with hypothermia: a prospective study.
abstract: BACKGROUND
  Neuron specific enolase (NSE) has repeatedly been evaluated for neurological prognostication in patients after cardiac arrest. However, it is unclear whether current guidelines for NSE cutoff levels also apply to cardiac arrest patients treated with hypothermia. Thus, we investigated the prognostic significance of absolute NSE levels and NSE kinetics in cardiac arrest patients treated with hypothermia.
  
  
  METHODS
  In a prospective study of 35 patients resuscitated from cardiac arrest, NSE was measured daily for four days following admission. Outcome was assessed at ICU discharge using the CPC score. All patients received hypothermia treatment for 24 hours at 33°C with a surface cooling device according to current guidelines.
  
  
  RESULTS
  The cutoff for absolute NSE levels in patients with unfavourable outcome (CPC 3-5) 72 hours after cardiac arrest was 57 μg/l with an area under the curve (AUC) of 0.82 (sensitivity 47%, specificity 100%). The cutoff level for NSE kinetics in patients with unfavourable outcome (CPC 3-5) was an absolute increase of 7.9 μg/l (AUC 0.78, sensitivity 63%, specificity 100%) and a relative increase of 33.1% (AUC 0.803, sensitivity 67%, specificity 100%) at 48 hours compared to admission.
  
  
  CONCLUSIONS
  In cardiac arrest patients treated with hypothermia, prognostication of unfavourable outcome by NSE kinetics between admission and 48 hours after resuscitation may be superior to prognostication by absolute NSE levels.
authors.affiliation: Department of Nephrology and Medical Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. christian.storm@charite.de
authors.forename: Christian
authors.initials: C
authors.lastname: Storm
authors.forename: Jens
authors.initials: J
authors.lastname: Nee
authors.forename: Achim
authors.initials: A
authors.lastname: Jörres
authors.forename: Christoph
authors.initials: C
authors.lastname: Leithner
authors.forename: Dietrich
authors.initials: D
authors.lastname: Hasper
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Ploner
mesh_terms: D000368:Aged; D019540:Area Under Curve; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood / Q000493:pharmacokinetics*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D010751:Phosphopyruvate Hydratase