Lee Dong Hun, Lee Byung Kook, Cho Yong Soo, Kim Dong Ki, Ryu Seok Jin, Min Jin Hong, Park Jung Soo, Jeung Kyung Woon
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Heliyon. 2024 Jul 14;10(14):e34618. doi: 10.1016/j.heliyon.2024.e34618. eCollection 2024 Jul 30.
We validated the prognostic performance of neuron-specific enolase (NSE) according to the recommended values in cardiac arrest (CA) survivors.
We analyzed the data of adult CA survivors who underwent targeted temperature management between January 2014 and December 2020. We measured the NSE level 48 h and 72 h after CA. We performed receiver operating characteristics (ROC) and used the reference value (17 μg/L) and the guidelines-suggested value (60 μg/L) as thresholds. The primary outcome was 6-month neurological outcomes with Cerebral Performance Category (CPC), dichotomized into good (CPC 1 or 2) or poor (CPC 3-5).
Of the 513 included patients, 346 (67.4 %) patients had poor neurological outcomes. The area under ROC (AUC) of NSE at 48 h was 0.887 (95 % confidence intervals [CIs], 0.851-0.909) with the Youden index of 35.6 μg/L. A false positive rate (FPR) of <2 % was observed (54.1 μg/L). The thresholds values (17, 60) had a sensitivity of 86.1% and 56.7 % and a specificity of 66.7%and 98.8 %, respectively. The AUC of NSE at 72 h was 0.892 (95 % CIs, 0.849-0.920) with the Youden index of 30.4 μg/L. The threshold values (17, 60) had a sensitivity of 86.0%and 59.4 % with a specificity of 72.2%and 98.3 %, respectively. An FPR of <2 % was observed (53.6 μg/L). Among the 156 patients and 113 patients with NSE at 48 h and at 72 h ≤ 17 μg/L, respectively, 109 and 83 patients had good neurological outcomes.
The cut-off value of NSE (60 μg/L) was acceptable to predict poor neurological outcomes with an FPR <2 % in cardiac arrest survivors, irrespective of at 48 or 72 h. NSE (17 μg/L) can function as mitigating factor to deter early WLST.
我们根据心脏骤停（CA）幸存者的推荐值验证了神经元特异性烯醇化酶（NSE）的预后性能。
我们分析了2014年1月至2020年12月期间接受目标温度管理的成年CA幸存者的数据。我们在CA后48小时和72小时测量NSE水平。我们进行了受试者工作特征（ROC）分析，并将参考值（17μg/L）和指南建议值（60μg/L）作为阈值。主要结局是6个月时的神经学结局，采用脑功能分类（CPC）进行评估，分为良好（CPC 1或2）或不良（CPC 3 - 5）。
在纳入的513例患者中，346例（67.4%）患者神经学结局不良。48小时时NSE的ROC曲线下面积（AUC）为0.887（95%置信区间[CI]，0.851 - 0.909），约登指数为35.6μg/L。观察到假阳性率（FPR）<2%（54.1μg/L）。阈值（17, 60）的敏感性分别为86.1%和56.7%，特异性分别为66.7%和98.8%。72小时时NSE的AUC为0.892（95% CI，0.849 - 0.920），约登指数为30.4μg/L。阈值（17, 60）的敏感性分别为86.0%和59.4%，特异性分别为72.2%和98.3%。观察到FPR<2%（53.6μg/L）。在48小时时NSE≤17μg/L的156例患者和72小时时NSE≤17μg/L的113例患者中分别有109例和83例患者神经学结局良好。
NSE的临界值（60μg/L）在预测心脏骤停幸存者不良神经学结局时是可接受的，FPR<2%，无论在48小时还是72小时。NSE（17μg/L）可作为减轻因素以避免早期放弃生命支持治疗。
