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Ability of neuron-specific enolase to predict survival to hospital discharge after successful cardiopulmonary resuscitation

Published online by Cambridge University Press:  21 May 2015

Johann Auer ,
Robert Berent ,
Thomas Weber ,
Michael Porodko ,
Gudrun Lamm ,
Elisabeth Lassnig ,
Edwin Maurer ,
Herbert Mayr ,
Christian Punzengruber  and
Bernd Eber
Johann Auer*
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Robert Berent
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Thomas Weber
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Michael Porodko
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Gudrun Lamm
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Elisabeth Lassnig
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Edwin Maurer
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Herbert Mayr
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Christian Punzengruber
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
Bernd Eber
Affiliation:
Department of Cardiology and Institute of Laboratory Medicine I, General Hospital Wels, Austria
*
Department of Cardiology and Intensive Care, General Hospital, Wels Grieskirchnerstraße 42 A-4600 Wels Austria; tel ++43-7242-415-2215, fax ++43-7242-415-3992, [email protected]

Abstract

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Background:

Accurate prediction of survival to hospital discharge in patients who achieve return of spontaneous circulation after cardiopulmonary resuscitation (CPR) has significant ethical and socioeconomic implications. We investigated the prognostic performance of serum neuron-specific enolase (NSE), a biochemical marker of ischemic brain injury, after successful CPR.

Methods:

In-hospital or out-of-hospital patients with nontraumatic normothermic cardiac arrest who achieved return of spontaneous circulation (ROSC) following at least 5 minutes of CPR were eligible. Neuron-specific enolase levels were assessed immediately, 6 hours, 12 hours and 2 days after ROSC. Subjects were followed to death or hospital discharge.

Results:

Seventeen patients (7 men, 10 women) were enrolled during a 1-year period. Median (range) NSE levels in survivors and non-survivors respectively were as follows: immediately after ROSC: 14.0 μg/L (9.1–51.4 μg/L) versus 25.9 μg/L (10.2–57.5 μg/L); 6 hours after ROSC: 15.2 μg/L (9.7–30.8 μg/L) versus 25.6 μg/L (12.7–38.2 μg/L); 12 hours after ROSC: 14.0 μg/L (8.6–32.4 μg/L) versus 28.5 μg/L (11.0–50.7 μg/L); and 48 hours after ROSC: 13.1 μg/L (7.8–29.5 μg/L) versus 52.0 μg/L (29.1–254.0 μg/L). Non-survivors had significantly higher NSE levels 48 hours after ROSC than surivors (p = 0.04) and showed a trend toward higher values during the entire time course following ROSC. An NSE concentration of >30 μg/L 48 hours after ROSC predicted death with a high specificity (100%: 95% confidence interval [CI] 85%–100%), and a level of 29 μg/L or less at 48 hours predicted survival with a high specificity (100%: 95% CI 83%–100%).

Conclusions:

Serum NSE levels may have clinical utility for the prediction of survival to hospital discharge in patients after ROSC following CPR over 5 minutes in duration. This study is small, and our results are limited by wide confidence intervals. Further research on ability of NSE to facilitate prediction and clinical decision-making after cardiac arrest is warranted.

Keywords

cardiopulmonary resuscitationcardiac arrestprognosispredictive value of testsoutcomeneuron-specific enolase
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 1 , January 2006 , pp. 13 - 18
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

References

1.Dorian, P, Cass, D, Schwartz, B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 2002;346:884–90.CrossRefGoogle ScholarPubMed
2.Kudenchuk, PJ, Cobb, LA, Copass, MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999;341:871–8.CrossRefGoogle ScholarPubMed
3.Longstreth, WT Jr, Diehr, P, Inui, TS.Prediction of awakening after out-of-hospital cardiac arrest. N Engl J Med 1983;308:1378–82.CrossRefGoogle ScholarPubMed
4.Levy, DE, Caronna, JJ, Singer, BH, et al. Predicting outcome from hypoxic-ischemic coma. JAMA 1985;253:1420–6.CrossRefGoogle ScholarPubMed
5.Scollo-Lavizzari, G, Bassetti, C.Prognostic value of EEG in post-anoxic coma after cardiac arrest. Eur Neurol 1987;26:161–70.CrossRefGoogle ScholarPubMed
6.Brunko, E, Zegers de Beyl, D.Prognostic value of early cortical somatosensory evoked potentials after resuscitation from cardiac arrest. Electroencephalogr Clin Neurophysiol 1987;66:15–24.CrossRefGoogle ScholarPubMed
7.Madl, C, Grimm, G, Kramer, L, et al. Early prediction of individual outcome after cardiopulmonary resuscitation. Lancet 1993;341:855–8.Google Scholar
8.Morimoto, Y, Kemmotsu, O, Kitami, K, et al. Acute brain swelling after out-of-hospital cardiac arrest: pathogenesis and outcome. Crit Care Med 1993;21:104–10.CrossRefGoogle ScholarPubMed
9.Rupright, J, Woods, EA, Singh, A.Hypoxic brain injury: evaluation by single photon emission computed tomography. Arch Phys Med Rehabil 1996;77:1205–8.CrossRefGoogle ScholarPubMed
10.Vaagenes, P, Mullie, A, Fodstad, DT, et al. The use of cytosolic enzyme increase in cerebrospinal fluid of patients resuscitated after cardiac arrest. Brain Resuscitation Clinical Trial I Study Group. Am J Emerg Med 1994;12:621–4.CrossRefGoogle ScholarPubMed
11.Karkela, J, Pasanen, M, Kaukinen, S, et al. Evaluation of hypoxic brain injury with spinal fluid enzymes, lactate, and pyruvate. Crit Care Med 1992;20:378–86.CrossRefGoogle ScholarPubMed
12.Hans, P, Bonhomme, V, Collette, J, et al. Neuron-specific enolase as a marker of in vitro neuronal damage. Part I: Assessment of neuron-specific enolase as a quantitative and specific marker of neuronal damage. J Neurosurg Anesthesiol 1993;5:111–6.CrossRefGoogle ScholarPubMed
13.Marangos, PJ, Schmechel, DE.Neuron specific enolase, a clinically useful marker for neurons and neuroendocrine cells. Annu Rev Neurosci 1987;10:269–95.CrossRefGoogle ScholarPubMed
14.Steinberg, R, Gueniau, C, Scarna, H, et al. Experimental brain ischemia: neuron-specific enolase level in cerebrospinal fluid as an index of neuronal damage. J Neurochem 1984;43:19–24.CrossRefGoogle ScholarPubMed
15.Schmechel, D, Marangos, PJ, Zis, AP, et al. Brain enolases as specific markers of neuronal and glial cells. Science 1978;199:313–5.CrossRefGoogle ScholarPubMed
16.Schmechel, D, Marangos, PJ, Brightman, M.Neurone-specific enolase is a molecular marker for peripheral and central neuroendocrine cells. Nature 1978;276:834–6.Google ScholarPubMed
17.Schoerkhuber, W, Kittler, H, Sterz, F, et al. Time course of serum neuron-specific enolase. A predictor of neurological outcome in patients resuscitated from cardiac arrest. Stroke 1999;30:1598–603.CrossRefGoogle ScholarPubMed
18.Persson, L, Hardemark, HG, Gustafsson, J, et al. S-100 protein and neuron-specific enolase in cerebrospinal fluid and serum: markers of cell damage in human central nervous system. Stroke 1987;18:911–8.CrossRefGoogle ScholarPubMed
19.Schaarschmidt, H, Prange, HW, Reiber, H.Neuron-specific enolase concentrations in blood as a prognostic parameter in cerebrovascular diseases. Stroke 1994;25:558–65.CrossRefGoogle ScholarPubMed
20.Mabe, H, Suzuki, S, Mase, M, et al. Serum neuron-specific enolase levels after subarachnoid hemorrhage. Surg Neurol 1991;36:170–4.CrossRefGoogle ScholarPubMed
21.Barone, FC, Clark, RK, Price, WJ, et al. Neuron-specific enolase increases in cerebral and systemic circulation following focal ischemia. Brain Res 1993;623:77–82.Google Scholar
22.Cunningham, RT, Watt, M, Winder, J, et al. Serum neurone-specific enolase as an indicator of stroke volume. Eur J Clin Invest 1996;26:298–303.Google Scholar
23.Martens, P, Raabe, A, Johnsson, P.Serum S-100 and neuron-specific enolase for prediction of regaining consciousness after global cerebral ischemia. Stroke 1998;29:2363–6.CrossRefGoogle ScholarPubMed
24.Dauberschmidt, R, Zinsmeyer, J, Mrochen, H, et al. Changes of neuron-specific enolase concentration in plasma after cardiac arrest and resuscitation. Mol Chem Neuropathol 1991;14:237–45.CrossRefGoogle ScholarPubMed
25.Fogel, W, Krieger, D, Veith, M, et al. Serum neuron-specific enolase as early predictor of outcome after cardiac arrest. Crit Care Med 1997;25:1133–8.CrossRefGoogle ScholarPubMed
26.Bassetti, C, Bomio, F, Mathis, J, et al. Early prognosis in coma after cardiac arrest: a prospective clinical, electrophysiological, and biochemical study of 60 patients. J Neurol Neurosurg Psychiatry 1996;61:610–5.CrossRefGoogle ScholarPubMed
27.Herrmann, M, Ebert, AD, Galazky, I, et al. Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke 2000;31:645–50.CrossRefGoogle ScholarPubMed
28.Jennett, B, Bond, M.Assessment of outcome after severe brain damage. Lancet 1975;1:480–4.CrossRefGoogle ScholarPubMed
29.Koller-Strametz, J, Fritzer, M, Gwechenberger, M, et al. Elevation of prostate-specific markers after cardiopulmonary resuscitation. Circulation 2000;102:290–3.CrossRefGoogle ScholarPubMed
30.Jacobs, P, Noseworthy, TW.National estimates of intensive care utilization and costs: Canada and the United States. Crit Care Med 1990;18:1282–6.CrossRefGoogle ScholarPubMed
31.Martens, P, Haymerle, A, Sterz, F, et al. Limitation of life support after resuscitation from cardiac arrest: practice in Belgium and Austria. Resuscitation 1997;35:123–8.CrossRefGoogle ScholarPubMed
32.Stelzl, T, von Bose, MJ, Hogl, B, et al. A comparison of the prognostic value of neuron-specific enolase serum levels and somatosensory evoked potentials in 13 reanimated patients. Eur J Emerg Med 1995;2:24–7.CrossRefGoogle ScholarPubMed
33.Burghuber, OC, Worofka, B, Schernthaner, G, et al. Serum neuron-specific enolase is a useful tumor marker for small cell lung cancer. Cancer 1990;65:1386–90.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
34.Zeltzer, PM, Marangos, PJ, Evans, AE, et al. Serum neuron-specific enolase in children with neuroblastoma: relationship to stage and disease course. Cancer 1986;57:1230–4.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
35.D’Alessandro, M, Mariani, P, Lomanto, D, et al. Serum neuron-specific enolase in diagnosis and follow-up of gastrointestinal neuroendocrine tumors. Tumour Biol 1992;13:352–7.CrossRefGoogle ScholarPubMed