Neuron-Specific Enolase Predicts Poor Outcome After Cardiac Arrest and Targeted Temperature Management: A Multicenter Study on 1,053 Patients
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- Kaspar Josche Streitberger
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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- Christoph Leithner
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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- Michael Wattenberg
- Department of Anesthesia, Surgical and Internal Intensive Care, Emergency Medical Services, Klinikum Links der Weser, Bremen, Germany.
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- Peter. H. Tonner
- Department of Anesthesia, Surgical and Internal Intensive Care, Emergency Medical Services, Klinikum Links der Weser, Bremen, Germany.
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- Julia Hasslacher
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University, Innsbruck, Austria.
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- Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University, Innsbruck, Austria.
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- Tommaso Pellis
- Department of Anesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy.
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- Elena Di Luca
- Department of Anesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy.
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- Markus Födisch
- Department of Anesthesia and Intensive and Emergency Care, Evangelisches Waldkrankenhaus, Bonn, Germany.
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- Alexander Krannich
- Department for Biostatistics, Coordination Center for Clinical Trials, Charité Universitätsmedizin Berlin, Berlin, Germany.
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- Christoph J. Ploner
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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- Christian Storm
- Department of Nephrology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
Description
<jats:sec><jats:title>Objective:</jats:title><jats:p>Outcome prediction after cardiac arrest is important to decide on continuation or withdrawal of intensive care. Neuron-specific enolase is an easily available, observer-independent prognostic biomarker. Recent studies have yielded conflicting results on its prognostic value after targeted temperature management.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Patients:</jats:title><jats:p>We analyzed neuron-specific enolase serum concentrations 3 days after nontraumatic in-hospital cardiac arrest and out-of-hospital cardiac arrest and outcome of patients from five hospitals in Germany, Austria, and Italy. Patients were treated at 33°C for 24 hours. Cerebral Performance Category was evaluated upon ICU discharge. We performed case reviews of good outcome patients with neuron-specific enolase greater than 90 μg/L and poor outcome patients with neuron-specific enolase less than or equal to 17 μg/L (upper limit of normal).</jats:p></jats:sec><jats:sec><jats:title>Measurements and Main Results:</jats:title><jats:p>A neuron-specific enolase serum concentration greater than 90 μg/L predicted Cerebral Performance Category 4–5 with a positive predictive value of 99%, false positive rate of 0.5%, and a sensitivity of 48%. All three patients with neuron-specific enolase greater than 90 μg/L and Cerebral Performance Category 1–2 had confounders for neuron-specific enolase elevation. An neuron-specific enolase serum concentration less than or equal to 17 μg/L excluded Cerebral Performance Category 4–5 with a negative predictive value of 92%. The majority of 14 patients with neuron-specific enolase less than or equal to 17 μg/L who died had a cause of death other than hypoxic-ischemic encephalopathy. Specificity and sensitivity for prediction of poor outcome were independent of age, sex, and initial rhythm but higher for out-of-hospital cardiac arrest than for in-hospital cardiac arrest patients.</jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p>High neuron-specific enolase serum concentrations reliably predicted poor outcome at ICU discharge. Prediction accuracy differed and was better for out-of-hospital cardiac arrest than for in-hospital cardiac arrest patients. Our “in-the-field” data indicate 90 μg/L as a threshold associated with almost no false positives at acceptable sensitivity. Confounders of neuron-specific enolase elevation should be actively considered: neuron-specific enolase–producing tumors, acute brain diseases, and hemolysis. We strongly recommend routine hemolysis quantification. Neuron-specific enolase serum concentrations less than or equal to 17 μg/L argue against hypoxic-ischemic encephalopathy incompatible with reawakening.</jats:p></jats:sec>
Journal
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- Critical Care Medicine
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Critical Care Medicine 45 (7), 1145-1151, 2017-07
Ovid Technologies (Wolters Kluwer Health)
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Details 詳細情報について
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- CRID
- 1362262945414458368
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- ISSN
- 00903493
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- Data Source
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- Crossref