Predictive power of serum NSE and OHCA score regarding 6-month neurologic outcome after out-of-hospital ventricular fibrillation and therapeutic hypothermia

• Published in: Resuscitation Vol. 80; no. 2; pp. 165 - 170
• Main Authors: Oksanen, Tuomas, Tiainen, Marjaana, Skrifvars, Markus B, Varpula, Tero, Kuitunen, Anne, Castrén, Maaret, Pettilä, Ville
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.02.2009; Elsevier
• Subjects: Age Factors; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Glucose - analysis; Cardiac arrest; Cardiopulmonary Resuscitation; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Glucose; Heart Arrest - therapy; Humans; Hypothermia; Hypothermia, Induced; Intensive care medicine; Intensive Care Units; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Multivariate Analysis; Neurologic Examination; NSE; Outcome; Outcome Assessment (Health Care); Phosphopyruvate Hydratase - blood; Prediction; Predictive Value of Tests; Prospective Studies; Resuscitation; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Time Factors; Ventricular Fibrillation - therapy; NSE; Outcome; Cardiac arrest; Prediction; Glucose; Resuscitation; Hypothermia; Cardiocirculatory arrest; Intensive care; Prognosis; Arrhythmia; Cardiovascular disease; Excitability disorder; Ventricular fibrillation; Treatment; Heart disease; Out of hospital
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2008.08.017

Summary Aim of the study To determine the predictive power of the out-of-hospital cardiac arrest (OHCA) score and serum neuron-specific enolase (NSE) in patients resuscitated from ventricular fibrillation treated with therapeutic hypothermia (TH) and glucose control. Methods An analysis of prospectively collected data of 90 TH patients. Serum NSE was measured at 24 and 48 h. Outcome was measured by neurologic exam 6 months after cardiac arrest with good outcome defined as a Cerebral Performance Category (CPC) of 1 or 2. Results In multiple logistic regression analysis, age (odds ratio [OR], 95% confidence interval 1.1 [1.03–1.18]/year), NSE at 48 h (OR 1.1 [1.02–1.26]/μg/l), and increase in NSE levels (OR 7.2 [1.7–31.3]) were predictors of poor outcome, but the OHCA score was not. Cut-off points with 100% specificity in predicting poor outcome were 33 μg/l for NSE at 48 h (sensitivity 43% [28–60%]) and 6.4 μg/l for delta NSE 24–48 h (sensitivity 44% [28–60%]). Conclusion Increase in NSE between 24 and 48 h and NSE at 48 h is specific but only moderately sensitive markers of 6-month outcome. Outcome prediction at ICU admission using the OHCA score was not possible in this selected patient population.