Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C

Pascal Stammet; Olivier Collignon; Christian Hassager; Matthew P Wise; Jan Hovdenes; Anders Åneman; Janneke Horn; Yvan Devaux; David Erlinge; Jesper Kjaergaard; Yvan Gasche; Michael Wanscher; Tobias Cronberg; Hans Friberg; Jørn Wetterslev; Tommaso Pellis; Michael Kuiper; Georges Gilson; Niklas Nielsen; TTM-Trial Investigators

doi:10.1016/j.jacc.2015.03.538

Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C

Pascal Stammet, Olivier Collignon, Christian Hassager, Matthew P Wise, Jan Hovdenes, Anders Åneman, Janneke Horn, Yvan Devaux, David Erlinge, Jesper Kjaergaard, Yvan Gasche, Michael Wanscher, Tobias Cronberg, Hans Friberg, Jørn Wetterslev, Tommaso Pellis, Michael Kuiper, Georges Gilson, Niklas Nielsen, TTM-Trial Investigators

150 Citationer (Scopus)

Abstract

Background Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. Objectives This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. Methods A total of 686 patients hospitalized after OHCA were randomized to targeted temperature management at either 33°C or 36°C. NSE levels were assessed in blood samples obtained 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was neurological outcome at 6 months using the cerebral performance category score. Results NSE was a robust predictor of neurological outcome in a baseline variable-adjusted model, and target temperature did not significantly affect NSE values. Median NSE values were 18 ng/ml versus 35 ng/ml, 15 ng/ml versus 61 ng/ml, and 12 ng/ml versus 54 ng/ml for good versus poor outcome at 24, 48, and 72 h, respectively (p < 0.001). At 48 and 72 h, NSE predicted neurological outcome with areas under the receiver-operating curve of 0.85 and 0.86, respectively. High NSE cutoff values with false positive rates ≤5% and tight 95% confidence intervals were able to reliably predict outcome. Conclusions High, serial NSE values are strong predictors of poor outcome after OHCA. Targeted temperature management at 33°C or 36°C does not significantly affect NSE levels. (Target Temperature Management After Cardiac Arrest [TTM]; NCT01020916)

Originalsprog	Engelsk
Tidsskrift	Journal of the American College of Cardiology
Vol/bind	65
Udgave nummer	19
Sider (fra-til)	2104-14
Antal sider	11
ISSN	0735-1097
DOI	https://doi.org/10.1016/j.jacc.2015.03.538
Status	Udgivet - 19 maj 2015

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10.1016/j.jacc.2015.03.538

Citationsformater

Stammet, P., Collignon, O., Hassager, C., Wise, M. P., Hovdenes, J., Åneman, A., Horn, J., Devaux, Y., Erlinge, D., Kjaergaard, J., Gasche, Y., Wanscher, M., Cronberg, T., Friberg, H., Wetterslev, J., Pellis, T., Kuiper, M., Gilson, G., Nielsen, N., & TTM-Trial Investigators (2015). Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C. Journal of the American College of Cardiology, 65(19), 2104-14. https://doi.org/10.1016/j.jacc.2015.03.538

Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C. / Stammet, Pascal; Collignon, Olivier; Hassager, Christian et al.

I: Journal of the American College of Cardiology, Bind 65, Nr. 19, 19.05.2015, s. 2104-14.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Stammet, P, Collignon, O, Hassager, C, Wise, MP, Hovdenes, J, Åneman, A, Horn, J, Devaux, Y, Erlinge, D, Kjaergaard, J, Gasche, Y, Wanscher, M, Cronberg, T, Friberg, H, Wetterslev, J, Pellis, T, Kuiper, M, Gilson, G, Nielsen, N & TTM-Trial Investigators 2015, 'Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C', Journal of the American College of Cardiology, bind 65, nr. 19, s. 2104-14. https://doi.org/10.1016/j.jacc.2015.03.538

@article{d0ab4c0a596b442e8b8050487199873d,

title = "Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C",

abstract = "Background Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. Objectives This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. Methods A total of 686 patients hospitalized after OHCA were randomized to targeted temperature management at either 33°C or 36°C. NSE levels were assessed in blood samples obtained 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was neurological outcome at 6 months using the cerebral performance category score. Results NSE was a robust predictor of neurological outcome in a baseline variable-adjusted model, and target temperature did not significantly affect NSE values. Median NSE values were 18 ng/ml versus 35 ng/ml, 15 ng/ml versus 61 ng/ml, and 12 ng/ml versus 54 ng/ml for good versus poor outcome at 24, 48, and 72 h, respectively (p < 0.001). At 48 and 72 h, NSE predicted neurological outcome with areas under the receiver-operating curve of 0.85 and 0.86, respectively. High NSE cutoff values with false positive rates ≤5% and tight 95% confidence intervals were able to reliably predict outcome. Conclusions High, serial NSE values are strong predictors of poor outcome after OHCA. Targeted temperature management at 33°C or 36°C does not significantly affect NSE levels.",

keywords = "Biomarkers, Brain Ischemia, Europe, Female, Follow-Up Studies, Humans, Hypothermia, Induced, Incidence, Male, Middle Aged, Out-of-Hospital Cardiac Arrest, Phosphopyruvate Hydratase, Prognosis, Prospective Studies, Temperature, Treatment Outcome",

author = "Pascal Stammet and Olivier Collignon and Christian Hassager and Wise, {Matthew P} and Jan Hovdenes and Anders {\AA}neman and Janneke Horn and Yvan Devaux and David Erlinge and Jesper Kjaergaard and Yvan Gasche and Michael Wanscher and Tobias Cronberg and Hans Friberg and J{\o}rn Wetterslev and Tommaso Pellis and Michael Kuiper and Georges Gilson and Niklas Nielsen and {TTM-Trial Investigators}",

year = "2015",

month = may,

day = "19",

doi = "10.1016/j.jacc.2015.03.538",

language = "English",

volume = "65",

pages = "2104--14",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "19",

}

TY - JOUR

T1 - Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C

AU - Stammet, Pascal

AU - Collignon, Olivier

AU - Hassager, Christian

AU - Wise, Matthew P

AU - Hovdenes, Jan

AU - Åneman, Anders

AU - Horn, Janneke

AU - Devaux, Yvan

AU - Erlinge, David

AU - Kjaergaard, Jesper

AU - Gasche, Yvan

AU - Wanscher, Michael

AU - Cronberg, Tobias

AU - Friberg, Hans

AU - Wetterslev, Jørn

AU - Pellis, Tommaso

AU - Kuiper, Michael

AU - Gilson, Georges

AU - Nielsen, Niklas

AU - TTM-Trial Investigators

PY - 2015/5/19

Y1 - 2015/5/19

N2 - Background Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. Objectives This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. Methods A total of 686 patients hospitalized after OHCA were randomized to targeted temperature management at either 33°C or 36°C. NSE levels were assessed in blood samples obtained 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was neurological outcome at 6 months using the cerebral performance category score. Results NSE was a robust predictor of neurological outcome in a baseline variable-adjusted model, and target temperature did not significantly affect NSE values. Median NSE values were 18 ng/ml versus 35 ng/ml, 15 ng/ml versus 61 ng/ml, and 12 ng/ml versus 54 ng/ml for good versus poor outcome at 24, 48, and 72 h, respectively (p < 0.001). At 48 and 72 h, NSE predicted neurological outcome with areas under the receiver-operating curve of 0.85 and 0.86, respectively. High NSE cutoff values with false positive rates ≤5% and tight 95% confidence intervals were able to reliably predict outcome. Conclusions High, serial NSE values are strong predictors of poor outcome after OHCA. Targeted temperature management at 33°C or 36°C does not significantly affect NSE levels.

AB - Background Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. Objectives This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. Methods A total of 686 patients hospitalized after OHCA were randomized to targeted temperature management at either 33°C or 36°C. NSE levels were assessed in blood samples obtained 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was neurological outcome at 6 months using the cerebral performance category score. Results NSE was a robust predictor of neurological outcome in a baseline variable-adjusted model, and target temperature did not significantly affect NSE values. Median NSE values were 18 ng/ml versus 35 ng/ml, 15 ng/ml versus 61 ng/ml, and 12 ng/ml versus 54 ng/ml for good versus poor outcome at 24, 48, and 72 h, respectively (p < 0.001). At 48 and 72 h, NSE predicted neurological outcome with areas under the receiver-operating curve of 0.85 and 0.86, respectively. High NSE cutoff values with false positive rates ≤5% and tight 95% confidence intervals were able to reliably predict outcome. Conclusions High, serial NSE values are strong predictors of poor outcome after OHCA. Targeted temperature management at 33°C or 36°C does not significantly affect NSE levels.

KW - Biomarkers

KW - Brain Ischemia

KW - Europe

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Hypothermia, Induced

KW - Incidence

KW - Male

KW - Middle Aged

KW - Out-of-Hospital Cardiac Arrest

KW - Phosphopyruvate Hydratase

KW - Prognosis

KW - Prospective Studies

KW - Temperature

KW - Treatment Outcome

U2 - 10.1016/j.jacc.2015.03.538

DO - 10.1016/j.jacc.2015.03.538

M3 - Journal article

C2 - 25975474

SN - 0735-1097

VL - 65

SP - 2104

EP - 2114

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 19

ER -

Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C

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