title: NSE and S-100B are not sufficiently predictive of neurologic outcome after therapeutic hypothermia for cardiac arrest.
abstract: BACKGROUND
  Prognostication of cardiac arrest survivors is challenging since therapeutic hypothermia (TH) has been introduced. We evaluated serum biomarkers and motor response.
  
  
  METHODS
  This was a retrospective data analysis including patients in the years 2007-2012. Blood was drawn and a neurological examination was performed on admission and every morning. Outcomes were evaluated 6 months after discharge and dichotomized into good (cerebral performance category (CPC)=1 or 2) and poor (CPC=3, 4 or 5).
  
  
  RESULTS
  123 patients (79.7% male, 63±14 years) received TH; 50% had a good outcome. On admission, S-100B (P=0.004) was significantly associated with the outcome, as well as neuron-specific enolase (NSE; P=0.020) and S-100B (P=0.004) on day 1 after admission. NSE on day 2, NSE progression from day 1 to 2 and motor response on day 3 also predicted the outcome (all P<0.001). NSE>33μgl(-1) only predicted a poor outcome with a specificity of 76%. An absent motor response on day 3 was the most sensitive marker (94%). NSE>41.1μgl(-1) combined with S-100B>0.461μgl(-1) on day 1 was the most specific marker (96%).
  
  
  CONCLUSIONS
  Although NSE and S-100B levels are associated with the outcome, the use of previously described cut-off values was insufficiently predictive of neurologic outcome. Caution should be exercised in the use of these tests to provide neuroprognostication.
authors.affiliation: Intensive Care Unit, Medizinische Klinik Innenstadt (Ludwig-Maximilians-Universität), Munich, Germany. Electronic address: tobias_zellner@gmx.de.
authors.forename: T
authors.initials: T
authors.lastname: Zellner
authors.forename: R
authors.initials: R
authors.lastname: Gärtner
authors.forename: J
authors.initials: J
authors.lastname: Schopohl
authors.forename: M
authors.initials: M
authors.lastname: Angstwurm
mesh_terms: D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000209:etiology; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000150:complications / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*
chemical_list: D015415:Biomarkers; D064568:S100 Calcium Binding Protein beta Subunit; D010751:Phosphopyruvate Hydratase
keywords: Cardiac arrest; Hypothermia; Neuron-specific enolase; Outcome; Prognostication; S-100B