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Review
. 2023 Dec 13;12(24):7655.
doi: 10.3390/jcm12247655.

Predictive Performance of Neuron-Specific Enolase (NSE) for Survival after Resuscitation from Cardiac Arrest: A Systematic Review and Meta-Analysis

Krzysztof Kurek  1 , Damian Swieczkowski  2 , Michal Pruc  3   4 , Monika Tomaszewska  1 , Wieslaw Jerzy Cubala  5 , Lukasz Szarpak  6   7   8
Affiliations
Review

Predictive Performance of Neuron-Specific Enolase (NSE) for Survival after Resuscitation from Cardiac Arrest: A Systematic Review and Meta-Analysis

Krzysztof Kurek et al. J Clin Med. .

Abstract

The prediction of outcomes following cardiac arrest continues to provide significant difficulties. A preferred strategy involves adopting a multimodal approach, which encompasses the careful evaluation of the biomarker neuron-specific enolase (NSE). This systematic review and meta-analysis aimed to gather and summarize new and existing evidence on the prediction effect of neuron-specific enolase for survival to hospital discharge among adult patients with cardiac arrest. We searched PubMed Central, Scopus, EMBASE databases, and the Cochrane Library without language restrictions from their inceptions until 30 October 2023 and checked the reference lists of the included studies. Pooled results were reported as standardized mean differences (SMDs) and were presented with corresponding 95% confidence intervals (CIs). The primary outcome was survival to hospital discharge (SHD). Eighty-six articles with 10,845 participants were included. NSE showed a notable degree of specificity in its ability to predict mortality as well as neurological status among individuals who experienced cardiac arrest (p < 0.05). This study demonstrates the ability to predict fatality rates and neurological outcomes, both during the time of admission and at various time intervals after cardiac arrest. The use of NSE in a multimodal neuroprognostication algorithm has promise in improving the accuracy of prognoses for persons who have undergone cardiac arrest.

Keywords: NSE; biological marker; biomarker; cardiac arrest; cardiopulmonary resuscitation; evidence-based medicine; meta-analysis; neuron-specific enolase; prognosis; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 6
Figure 6
Neuron-specific enolase levels at 0, 1, 2, 3, 5, and 7 days after cardiopulmonary resuscitation in good and poor neurological outcome groups.
Figure 1
Figure 1
Flow diagram of the search strategy and study selection.
Figure 2
Figure 2
The number and distribution of articles used in the meta-analysis on survival rate and neurological status.
Figure 3
Figure 3
Forest plot of NSE levels among surviving vs. non-surviving patients measured at baseline. The center of each square represents the standardized mean differences for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results.
Figure 4
Figure 4
Forest plot of NSE levels among surviving vs. non-surviving patients measured at 6, 12, 24, 48, and 72 h after cardiac arrest. The center of each square represents the standardized mean differences for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results.
Figure 5
Figure 5
Neuron-specific enolase levels at 6, 12, 24, 48, and 72 h after cardiopulmonary resuscitation in survivors and non-survivors.
See this image and copyright information in PMC

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