Lascarrou Jean-Baptiste, Miailhe Arnaud-Félix, le Gouge Amélie, Cariou Alain, Dequin Pierre-François, Reignier Jean, Coupez Elisabeth, Quenot Jean-Pierre, Legriel Stephane, Pichon Nicolas, Thevenin Didier, Boulain Thierry, Frat Jean-Pierre, Vimeux Sylvie, Colin Gwenhael, Desroys du Roure François
Medecine Intensive Reanimation, University Hospital Centre, Nantes, France; Paris Cardiovascular Research Centre, INSERM U970, Paris, France; AfterROSC Network, France.
Medecine Intensive Reanimation, University Hospital Centre, Nantes, France.
Resuscitation. 2021 Jan;158:193-200. doi: 10.1016/j.resuscitation.2020.11.035. Epub 2020 Dec 8.
Prognostication of hypoxic-ischaemic brain injury after resuscitation from cardiac arrest is based on a multimodal approach including biomarker assays. Our goal was to assess whether plasma NSE helps to predict day-90 death or poor neurological outcome in patients resuscitated from cardiac arrest in non-shockable rhythm.
All included patients participated in the randomised multicentre HYPERION trial. Serum blood samples were taken 24, 48, and 72 h after randomisation; pre-treated, aliquoted, and frozen at -80 °C at the study sites; and shipped to a central biology laboratory, where the NSE assays were performed. Primary outcome was neurological status at day 90 assessed by Cerebral Performance Category (1 or 2 versus. 3, 4 or 5).
NSE was assayed in 235 assessable blood samples from 101 patients. In patients with good versus poor outcomes, median NSE values at 24, 48, and 72 h were 22.6 [95%CI, 14.6;27.3] ng/mL versus 33.6 [20.5;90.0] ng/mL (p < 0.04), 18.1 [11.7;29.7] ng/mL versus 76.8 [21.5;206.6] ng/mL (p < 0.0029), and 9 [6.1;18.6] ng/mL versus 80.5 [22.9;236.1] ng/mL (p < 0.001), respectively. NSE at 48 and 72 h predicted the neurological outcome with areas under the receiver-operating curve of 0.79 [95%CI, 0.69;0.96] and 0.9 [0.81;0.96], respectively. NSE levels did not differ significantly between the groups managed at 33°C and 37°C (p = 0.59).
Data from a multicentre trial on cardiac arrest with a non-shockable rhythm due to any cause confirm that NSE values at 72 h are associated with 90-day outcome. NSE levels did not differ significantly according to the targeted temperature.
ClinicalTrial NCT02722473.
心脏骤停复苏后缺氧缺血性脑损伤的预后评估基于多模式方法，包括生物标志物检测。我们的目标是评估血浆神经元特异性烯醇化酶（NSE）是否有助于预测非可电击心律心脏骤停复苏患者90天时的死亡或不良神经结局。
所有纳入患者均参与了随机多中心HYPERION试验。随机分组后24、48和72小时采集血清血样；在研究地点进行预处理、分装并在-80°C冷冻；然后运至中央生物学实验室进行NSE检测。主要结局是90天时通过脑功能分类评估的神经状态（1或2级与3、4或5级）。
对101例患者的235份可评估血样进行了NSE检测。预后良好与不良的患者，24、48和72小时的NSE中位数分别为22.6 [95%CI，14.6；27.3] ng/mL对33.6 [20.5；90.0] ng/mL（p < 0.04）、18.1 [11.7；29.7] ng/mL对76.8 [21.5；206.6] ng/mL（p < 0.0029）、9 [6.1；18.6] ng/mL对80.5 [22.9；236.1] ng/mL（p < 0.001）。48和72小时的NSE预测神经结局的受试者工作特征曲线下面积分别为0.79 [95%CI，0.69；0.96]和0.9 [0.81；0.96]。33°C和37°C处理组之间的NSE水平无显著差异（p = 0.59）。
一项关于因任何原因导致非可电击心律心脏骤停的多中心试验数据证实，72小时的NSE值与90天结局相关。根据目标温度，NSE水平无显著差异。
ClinicalTrial NCT02722473。
