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Comparative Study
. 2010;14(2):R69.
doi: 10.1186/cc8975. Epub 2010 Apr 19.

Mild therapeutic hypothermia alters neuron specific enolase as an outcome predictor after resuscitation: 97 prospective hypothermia patients compared to 133 historical non-hypothermia patients

Ingo G Steffen  1 , Dietrich Hasper, Christoph J Ploner, Joerg C Schefold, Ekkehart Dietz, Frank Martens, Jens Nee, Anne Krueger, Achim Jörres, Christian Storm
Affiliations
Comparative Study

Mild therapeutic hypothermia alters neuron specific enolase as an outcome predictor after resuscitation: 97 prospective hypothermia patients compared to 133 historical non-hypothermia patients

Ingo G Steffen et al. Crit Care. 2010.

Abstract

Introduction: 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.

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Figures

Figure 1
Figure 1
NSE serum levels (a) and neurological outcome (b) of patients treated with mild hypothermia and non-hypothermia group.
Figure 2
Figure 2
Association of neurological outcome (CPC 1-2 vs. CPC 3-5) and NSE serum level ranges.
Figure 3
Figure 3
Interaction of NSE serum level and mild hypothermia treatment (MTH) for prediction of neurological outcome.
Figure 4
Figure 4
ROC analysis of CPC 1 to 2 vs. CPC 3 to 5 for patients treated with mild therapeutic hypothermia and non-hypothermia group. Circles with white background mark the best cutoff point (minimal distance to left upper corner); NSE cutoff values are given in μg/l. Solid circles mark cutoff points with 100% specificity.
Figure 5
Figure 5
Kaplan-Meier survival curves of hypothermia and non-hypothermia group.
See this image and copyright information in PMC

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