Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
PLoS One. 2021 Jan 7;16(1):e0245210. doi: 10.1371/journal.pone.0245210. eCollection 2021.
Neuron-specific enolase (NSE) and S-100b have been used to assess neurological damage following out-of-hospital cardiac arrest (OHCA). Cut-offs were derived from small normothermic cohorts. Whether similar cut-offs apply to patients treated with hypothermia remained undetermined.
We investigated 251 patients with OHCA treated with hypothermia but without routine prognostication. Neuromarkers were determined at day 3, neurological outcome was assessed after hospital discharge by cerebral performance category (CPC).
Good neurological outcome (CPC≤2) was achieved in 41%. Elevated neuromarkers, older age and absence of ST-segment elevation after ROSC were associated with increased mortality. Poor neurological outcome in survivors was additionally associated with history of cerebrovascular events, sepsis and higher admission lactate. Mean NSE was 33μg/l [16-94] vs. 119μg/l [25-406]; p<0.001, for survivors vs. non-survivors, and 21μg/l [16-29] vs. 40μg/l [23-98], p<0.001 for good vs. poor neurological outcome. S-100b was 0.127μg/l [0.063-0.360] vs. 0.772μg/l [0.121-2.710], p<0.001 and 0.086μg/l [0.061-0.122] vs. 0.138μg/l [0.090-0.271], p = 0.009, respectively. For mortality, thresholds of 36μg/l for NSE and 0.128μg/l for S-100b could be determined; for poor neurological outcome 33μg/l (NSE) and 0.123μg/l (S-100b), respectively. Positive predictive value for NSE was 81% (74-88) and 79% (71-85) for S-100b.
Thresholds for NSE and S-100b predicting mortality and poor neurological outcome are similar in OHCA patients receiving therapeutic hypothermia as in those reported before the era of hypothermia. However, both biomarkers do not have enough specificity to predict mortality or poor neurological outcome on their own and should only be additively used in clinical decision making.
神经元特异性烯醇化酶（NSE）和 S-100b 已被用于评估院外心脏骤停（OHCA）后的神经损伤。这些截断值是从小样本的正常体温队列中得出的。在接受低温治疗的患者中是否存在类似的截断值尚不确定。
我们研究了 251 例接受低温治疗但未常规进行预后评估的 OHCA 患者。在第 3 天测定神经标志物，出院后通过脑功能分类（CPC）评估神经功能结局。
41%的患者获得良好的神经功能结局（CPC≤2）。神经标志物升高、年龄较大和 ROSC 后无 ST 段抬高与死亡率增加相关。幸存者的不良神经结局还与脑血管事件、败血症和入院时较高的血乳酸水平相关。存活者的平均 NSE 为 33μg/l [16-94]，而非存活者为 119μg/l [25-406]；p<0.001，存活者的 NSE 为 21μg/l [16-29]，而非存活者为 40μg/l [23-98]；p<0.001，用于幸存者与非幸存者，S-100b 为 0.127μg/l [0.063-0.360]，而非幸存者为 0.772μg/l [0.121-2.710]；p<0.001，用于幸存者与非幸存者，S-100b 为 0.086μg/l [0.061-0.122]，而非幸存者为 0.138μg/l [0.090-0.271]；p = 0.009，用于良好的神经结局与不良的神经结局。对于死亡率，可以确定 NSE 的截断值为 36μg/l，S-100b 的截断值为 0.128μg/l；对于不良神经结局，NSE 的截断值为 33μg/l（NSE）和 S-100b 的截断值为 0.123μg/l（S-100b）。NSE 的阳性预测值为 81%（74-88），S-100b 的阳性预测值为 79%（71-85）。
在接受治疗性低温的 OHCA 患者中，预测死亡率和不良神经结局的 NSE 和 S-100b 截断值与低温时代之前报告的截断值相似。然而，这两种生物标志物都没有足够的特异性来单独预测死亡率或不良神经结局，并且仅应在临床决策中附加使用。
