Predictive power of serum NSE and OHCA score regarding 6-month neurologic outcome after out-of-hospital ventricular fibrillation and therapeutic hypothermia.

Abstract

AIM OF THE STUDY:

To determine the predictive power of the out-of-hospital cardiac arrest (OHCA) score and serum neuron-specific enolase (NSE) in patients resuscitated from ventricular fibrillation treated with therapeutic hypothermia (TH) and glucose control.

METHODS:

An analysis of prospectively collected data of 90 TH patients. Serum NSE was measured at 24 and 48 h. Outcome was measured by neurologic exam 6 months after cardiac arrest with good outcome defined as a Cerebral Performance Category (CPC) of 1 or 2.

RESULTS:

In multiple logistic regression analysis, age (odds ratio [OR], 95% confidence interval 1.1 [1.03-1.18]/year), NSE at 48 h (OR 1.1 [1.02-1.26]/microg/l), and increase in NSE levels (OR 7.2 [1.7-31.3]) were predictors of poor outcome, but the OHCA score was not. Cut-off points with 100% specificity in predicting poor outcome were 33microg/l for NSE at 48h (sensitivity 43% [28-60%]) and 6.4microg/l for delta NSE 24-48 h (sensitivity 44% [28-60%]).

CONCLUSION:

Increase in NSE between 24 and 48h and NSE at 48h is specific but only moderately sensitive markers of 6-month outcome. Outcome prediction at ICU admission using the OHCA score was not possible in this selected patient population.

• Authors: Tuomas Oksanen, Marjaana Tiainen, Markus B Skrifvars, Tero Varpula, Anne Kuitunen, Maaret Castrén, Ville Pettilä
• Journal: Resuscitation (Resuscitation) Vol. 80 Issue 2 Pg. 165-70 (Feb 2009) ISSN: 0300-9572 [Print] Ireland
• PMID: 18954930 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Phosphopyruvate Hydratase

Topics

• Age Factors
• Aged
• Blood Glucose (analysis)
• Cardiopulmonary Resuscitation
• Female
• Heart Arrest (therapy)
• Humans
• Hypothermia, Induced
• Intensive Care Units
• Male
• Middle Aged
• Multivariate Analysis
• Neurologic Examination
• Outcome Assessment, Health Care
• Phosphopyruvate Hydratase (blood)
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Sensitivity and Specificity
• Severity of Illness Index
• Time Factors
• Ventricular Fibrillation (therapy)