Different neuroprognostication thresholds of neuron-specific enolase in shockable and non-shockable out-of-hospital cardiac arrest: a prospective multicenter observational study in Korea (the KORHN-PRO registry)

Critical Care

Research

Won Young Kim¹  Youn-Jung Kim¹  Byung Kook Lee²  In Soo Cho³  Su Jin Kim⁴  Chun Song Youn⁵  Joo Suk Oh⁶  Jung Hee Wee⁷  Yoo Seok Park⁸  Yong Hwan Kim⁹ 

[1] Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea;Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea;Department of Emergency Medicine, Hanil General Hospital, Seoul, Korea;Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea;Department of Emergency Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea;Department of Emergency Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu-si, Korea;Department of Emergency Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea;Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea;Departments of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea;

关键词: Out-of-hospital cardiac arrest;    Neuron-specific enolase;    Shockable rhythm;    Non-shockable rhythm;    Prognosis;   

DOI  :  10.1186/s13054-023-04603-6

 received in 2023-06-26, accepted in 2023-08-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSerum neuron-specific enolase (NSE) is the only recommended biomarker for multimodal prognostication in postcardiac arrest patients, but low sensitivity of absolute NSE threshold limits its utility. This study aimed to evaluate the prognostic performance of serum NSE for poor neurologic outcome in out-of-hospital cardiac arrest (OHCA) survivors based on their initial rhythm and to determine the NSE cutoff values with false positive rate (FPR) < 1% for each group.MethodsThis study included OHCA survivors who received targeted temperature management (TTM) and had serum NSE levels measured at 48 h after return of spontaneous circulation in the Korean Hypothermia Network, a prospective multicenter registry from 22 university-affiliated teaching hospitals in South Korea between October 2015 and December 2018. The primary outcome was poor outcome at 6 month, defined as a cerebral performance category of 3–5.ResultsOf 623 patients who underwent TTM with NSE measured 48 h after the return of spontaneous circulation, 245 had an initial shockable rhythm. Median NSE level was significantly higher in the non-shockable group than in the shockable group (104.6 [40.6–228.4] vs. 25.9 [16.7–53.4] ng/mL, P < 0.001). Prognostic performance of NSE assessed by area under the receiver operating characteristic curve to predict poor outcome was significantly higher in the non-shockable group than in the shockable group (0.92 vs 0.86). NSE cutoff values with an FPR < 1% in the non-shockable and shockable groups were 69.3 (sensitivity of 42.1%) and 102.7 ng/mL (sensitivity of 76%), respectively.ConclusionNSE prognostic performance and its cutoff values with FPR < 1% for predicting poor outcome in OHCA survivors who underwent TTM differed between shockable and non-shockable rhythms, suggesting postcardiac arrest survivor heterogeneity.Trial registration KORHN-PRO, NCT02827422. Registered 11 September 2016—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02827422

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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