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BMC Cardiovascular Disorders

, 11:48

First Online: 08 August 2011Received: 25 February 2011Accepted: 08 August 2011

Abstract

BackgroundThe prediction of neurological outcome in comatose patients after cardiac arrest has major ethical and socioeconomic implications. The purpose of this study was to assess the capability of serum neuron-specific enolase NSE, a biomarker of hypoxic brain damage, to predict death or vegetative state in comatose cardiac-arrest survivors.

MethodsWe conducted a prospective observational cohort study in one university hospital and one general hospital Intensive Care Unit ICU. All consecutive patients who suffered cardiac arrest and were subsequently admitted from June 2007 to February 2009 were considered for inclusion in the study. Patients who died or awoke within the first 48 hours of admission were excluded from the analysis. Patients were followed for 3 months or until death after cardiopulmonary resuscitation. The Cerebral Performance Categories scale CPC was used as the outcome measure; a CPC of 4-5 was regarded as a poor outcome, and a CPC of 1-3 a good outcome. Measurement of serum NSE was performed at 24 h and at 72 h after the time of cardiac arrest using an enzyme immunoassay. Clinicians were blinded to NSE results.

ResultsNinety-seven patients were included. All patients were actively supported during the first days following cardiac arrest. Sixty-five patients 67% underwent cooling after resuscitation. At 3 months 72 74% patients had a poor outcome CPC 4-5 and 25 26% a good outcome CPC 1-3. The median and Interquartile Range IQR levels of NSE at 24 h and at 72 h were significantly higher in patients with poor outcomes: NSE at 24 h: 59.4 ng-mL 37-106 versus 28.8 ng-mL 18-41 p < 0.0001; and NSE at 72 h: 129.5 ng-mL 40-247 versus 15.7 ng-mL 12-19 p < 0.0001. The Receiver Operator Characteristics ROC curve for poor outcome for the highest observed NSE value for each patient determined a cut-off value for NSE of 97 ng-mL to predict a poor neurological outcome with a specificity of 100% 95% CI = 87-100 and a sensitivity of 49% 95% CI = 37-60. However, an approach based on a combination of SSEPs, NSE and clinical-EEG tests allowed to increase the number of patients 63-72 88% identified as having a poor outcome and for whom intensive treatment could be regarded as futile.

ConclusionNSE levels measured early in the course of patient care for those who remained comatose after cardiac arrest were significantly higher in patients with outcomes of death or vegetative state. In addition, we provide a cut-off value for NSE > 97 ng-mL with 100% positive predictive value of poor outcome. Nevertheless, for decisions concerning the continuation of treatment in this setting, we emphasize that an approach based on a combination of SSEPs, NSE and clinical EEG would be more accurate for identifying patients with a poor neurological outcome.

AbbreviationsEEGElectro-Encephalography

GPCPCGlasgow-Pittsburgh Cerebral Performance Category

NSENeuron-Specific Enolase

SSEPsSomatosensory Evoked Potentials

ROCReceiver Operating Characteristics.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2261-11-48 contains supplementary material, which is available to authorized users.

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Author: Cédric Daubin - Charlotte Quentin - Stéphane Allouche - Olivier Etard - Cathy Gaillard - Amélie Seguin - Xavier Valette

Source: https://link.springer.com/article/10.1186/1471-2261-11-48







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