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. 2023 Aug 28;3(4):oead078.
doi: 10.1093/ehjopen/oead078. eCollection 2023 Jul.

Predicting poor neurological outcomes following out-of-hospital cardiac arrest using neuron-specific enolase and neurofilament light chain in patients with and without haemolysis

Yusuf Abdi Isse  1 , Ruth Frikke-Schmidt  2   3 , Sebastian Wiberg  1 , Johannes Grand  1 , Laust E R Obling  1 , Anna Sina Pettersson Meyer  1 , Jesper Kjaergaard  1   3 , Christian Hassager  1   3 , Martin A S Meyer  1
Affiliations

Predicting poor neurological outcomes following out-of-hospital cardiac arrest using neuron-specific enolase and neurofilament light chain in patients with and without haemolysis

Yusuf Abdi Isse et al. Eur Heart J Open. .

Abstract

Aims: Hypoxic-ischaemic brain injury following out-of-hospital cardiac arrest (OHCA) is a common complication and a major cause of death. Neuron-specific enolase (NSE) and neurofilament light chain (NfL) are released after brain injury and elevated concentrations of both are associated with poor neurological outcome. We explored the influence of haemolysis on the prognostic performance of NSE and NfL.

Methods and results: The study is based on post hoc analyses of a randomized, single-centre, double-blinded, controlled trial (IMICA), where comatose OHCA patients of presumed cardiac cause were included. Free-haemoglobin was measured at admission to quantify haemolysis. NSE and NfL were measured after 48 h to estimate the extent of brain injury. Montreal Cognitive Assessment score (MoCA) was assessed to evaluate neurocognitive impairments. Seventy-three patients were included and divided into two groups by the median free-haemoglobin at admission. No group differences in mortality or poor neurological outcome were observed. The high-admission free-haemoglobin group had a significantly higher concentration of NSE compared to the low-admission free-haemoglobin group (27.4 µmol/L vs. 19.6 µmol/L, P = 0.03), but no differences in NfL. The performance of NSE and NfL in predicting poor neurological outcome were high for both, but NfL was numerically higher [area under the ROC (AUROC) 0.90 vs. 0.96, P = 0.09]. Furthermore, NfL, but not NSE, was inversely correlated with MoCA score, R2 = 0.21, P = 0.006.

Conclusion: High free-haemoglobin at admission was associated with higher NSE concentration after 48 h, but, the performance of NSE and NfL in predicting poor neurological outcome among OHCA patients were good regardless of early haemolysis. Only elevated NfL concentrations were associated with cognitive impairments.

Keywords: Free-haemoglobin; Haemolysis; MoCA; Neurofilament light chain; Neuron-specific enolase; Out-of-hospital cardiac arrest.

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Conflict of interest statement

Conflicts of interest: All authors declare no conflict of interest except Anna Sina Petterson Meyer which has been employed at Novo Nordisk after the completion of the trial.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Prognostic performance of neuron-specific enolase and neurofilament light chain in predicting poor neurological outcome after out-of-hospital cardiac arrest. Receiver operating characteristic plot showing the predictive ability of neuron-specific enolase and neurofilament light chain measured at 48 h after admission to predict poor neurological outcome (Cerebral performance category ≥3) at 180 days after out-of-hospital cardiac arrest in comatose patients. The sample size is divided into two groups: a non-haemolysis group (< median haemolysis) and a haemolysis group (≥ median haemolysis). (A) All patients. (B) Non-haemolysis group. (C) Haemolysis group.
See this image and copyright information in PMC

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