Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
PLoS One. 2024 Jun 25;19(6):e0305771. doi: 10.1371/journal.pone.0305771. eCollection 2024.
Research on prognostic factors for good outcomes in out-of-hospital cardiac arrest (OHCA) survivors is lacking. We assessed whether normal levels of normal neuron-specific enolase (NSE) value would be useful for predicting good neurological outcomes in comatose OHCA survivors treated with targeted temperature management (TTM). This registry-based observational study with consecutive adult (≥18 years) OHCA survivors with TTM who underwent NSE measurement 48 hours after cardiac arrest was conducted from October 2015 to November 2022. Normal NSE values defined as the upper limit of the normal range by the manufacturer (NSE <16.3 μg/L) and guideline-suggested (NSE < 60 μg/L) were examined for good neurologic outcomes, defined as Cerebral Performance Categories ≤2, at 6 months post-survival. Among 226 OHCA survivors with TTM, 200 patients who underwent NSE measurement were enrolled. The manufacturer-suggested normal NSE values (<16.3 μg/L) had a specificity of 99.17% for good neurological outcomes with a very low sensitivity of 12.66%. NSE <60 μg/L predicted good outcomes with a sensitivity of 87.34% and specificity of 72.73%. However, excluding 14 poor-outcome patients who died from multi-organ dysfunction excluding hypoxic brain injury, the sensitivity and specificity of normal NSE values were 12.66% and 99.07% of NSE < 16.3 μg/L, and 87.34% and 82.24% of NSE < 60 μg/L. The manufacturer-suggested normal NSE had high specificity with low sensitivity, but the guideline-suggested normal NSE value had a comparatively low specificity for good outcome prediction in OHCA survivors. Our data demonstrate normal NSE levels can be useful as a tool for multimodal appropriation of good outcome prediction.
院外心脏骤停（OHCA）幸存者预后因素的研究较少。我们评估了在接受目标温度管理（TTM）治疗的昏迷 OHCA 幸存者中，正常神经元特异性烯醇化酶（NSE）水平是否可用于预测良好的神经结局。这是一项基于登记的观察性研究，纳入了 2015 年 10 月至 2022 年 11 月期间接受 TTM 治疗的连续成年（≥18 岁）OHCA 幸存者，这些患者在心脏骤停后 48 小时进行了 NSE 测量。正常 NSE 值定义为制造商（NSE <16.3 μg/L）和指南建议（NSE < 60 μg/L）的正常范围上限，用于 6 个月后存活的患者的良好神经结局（Cerebral Performance Categories ≤2）。在 226 名接受 TTM 的 OHCA 幸存者中，纳入了 200 名接受 NSE 测量的患者。制造商建议的正常 NSE 值（<16.3 μg/L）对良好神经结局的特异性为 99.17%，敏感性非常低，为 12.66%。NSE <60 μg/L 预测良好结局的敏感性为 87.34%，特异性为 72.73%。然而，排除了 14 名因缺氧性脑损伤以外的多器官功能障碍而死亡的预后不良患者后，NSE <16.3 μg/L 的正常 NSE 值的敏感性和特异性分别为 12.66%和 99.07%，NSE <60 μg/L 的敏感性和特异性分别为 87.34%和 82.24%。制造商建议的正常 NSE 值具有高特异性和低敏感性，但指南建议的正常 NSE 值对 OHCA 幸存者良好结局预测的特异性相对较低。我们的数据表明，正常 NSE 水平可用作预测良好结局的多模态工具。
