Universität zu Köln

Huntgeburth, Michael, Adler, Christoph, Rosenkranz, Stephan, Zobel, Carsten, Haupt, Walter F., Dohmen, Christian and Reuter, Hannes (2014). Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest. Neurocrit. Care, 20 (3). S. 358 - 367. TOTOWA: HUMANA PRESS INC. ISSN 1556-0961

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Abstract

To determine neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA) and treatment with mild therapeutic hypothermia (MTH). Seventy-three consecutive OHCA patients treated with MTH were retrospectively analyzed. Serum neuron-specific enolase (NSE) was measured 24, 48, and 72 h after admission. In patients with no motor response 48 h after termination of analgosedation (n = 40), clinical neurological examination and evoked potentials (EPs) were determined. Neurological outcome was assessed after 2 months based on the cerebral performance categories (CPC), and categorized as good (CPC 1-3) or poor (CPC 4 and 5). Forty-three patients had a CPC score of 1-3 and 30 patients had a CPC 4-5. The best predictive value for poor neurologic outcome was an increase of NSE by a parts per thousand yen4.3 ng/mL between day 1 and day 2 (sensitivity 80 %, specificity 100 %, positive predictive value (PPV) 100 %, negative predictive value 86 %). Absolute NSE values were less reliable in the prediction of poor outcome with the highest sensitivity (88 %) and specificity (95 %) if values reached a parts per thousand yen36.3 ng/mL on day 3. Somatosensory EPs (SSEPs) showed a specificity of 100 % and PPV of 100 %; however, sensitivity for evoked potentials was low (29 %). Intriguingly, two initially comatose patients with excessive NSE values (24 h NSE: 101 and 256 ng/mL, and 48 h NSE: 93 and 110 ng/mL, respectively) had physiological SSEPs and regained a CPC score of 1. In patients treated with MTH after OHCA changes in NSE are more suitable than its absolute serum levels for the prediction of poor neurologic outcome. Since unequivocal prediction of poor neurologic outcome is of utmost importance in these patients the decision to limit therapy must be based on several prediction tools with the highest PPV and specificity including SSEPs.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Huntgeburth, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Adler, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenkranz, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Zobel, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Haupt, Walter F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dohmen, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Reuter, Hannes UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-436977
DOI:	10.1007/s12028-013-9848-8
Journal or Publication Title:	Neurocrit. Care
Volume:	20
Number:	3
Page Range:	S. 358 - 367
Date:	2014
Publisher:	HUMANA PRESS INC
Place of Publication:	TOTOWA
ISSN:	1556-0961
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MILD THERAPEUTIC HYPOTHERMIA; RESUSCITATION COUNCIL GUIDELINES; EMERGENCY CARDIOVASCULAR CARE; HEART-ASSOCIATION GUIDELINES; CARDIOPULMONARY-RESUSCITATION; EVOKED-POTENTIALS; COMATOSE SURVIVORS; PROSPECTIVE COHORT; CLINICAL MEDICINE; S-100B Multiple languages Critical Care Medicine; Clinical Neurology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43697