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Single versus seria...
Single versus serial measurements of neuron-specific enolase and prediction of poor neurological outcome in persistently unconscious patients after out-of-hospital cardiac arrest - A TTM-trial substudy
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- Wiberg, Sebastian (author)
- Copenhagen University Hospital
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- Hassager, Christian (author)
- Copenhagen University Hospital
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- Stammet, Pascal (author)
- Centre Hospitalier de Luxembourg
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- Winther-Jensen, Matilde (author)
- Copenhagen University Hospital
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- Thomsen, Jakob Hartvig (author)
- Copenhagen University Hospital
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- Erlinge, David (author)
- Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
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- Wanscher, Michael (author)
- Copenhagen University Hospital
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- Nielsen, Niklas (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Helsingborg Hospital
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- Pellis, Tommaso (author)
- Santa Maria degli Angeli Hospital
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- Åneman, Anders (author)
- Liverpool Hospital
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- Friberg, Hans (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
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- Hovdenes, Jan (author)
- Oslo university hospital
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- Horn, Janneke (author)
- Academic Medical Center of University of Amsterdam (AMC)
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- Wetterslev, Jørn (author)
- Copenhagen University Hospital
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- Bro-Jeppesen, John (author)
- Copenhagen University Hospital
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- Wise, Matthew P (author)
- University Hospital of Wales
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- Kuiper, Michael (author)
- Medical Center Leeuwarden
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- Cronberg, Tobias (author)
- Lund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
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- Gasche, Yvan (author)
- Geneva University Hospital
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- Devaux, Yvan (author)
- Luxembourg Institute of Health
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- Kjaergaard, Jesper (author)
- Copenhagen University Hospital
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(creator_code:org_t)
- 2017-01-18
- 2017
- English.
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:1
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Abstract
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- Background: Prediction of neurological outcome is a crucial part of post cardiac arrest care and prediction in patients remaining unconscious and/or sedated after rewarming from targeted temperature management (TTM) remains difficult. Current guidelines suggest the use of serial measurements of the biomarker neuron-specific enolase (NSE) in combination with other predictors of outcome in patients admitted after out-of-hospital cardiac arrest (OHCA). This study sought to investigate the ability of NSE to predict poor outcome in patients remaining unconscious at day three after OHCA. In addition, this study sought to investigate if serial NSE measurements add incremental prognostic information compared to a single NSE measurement at 48 hours in this population. Methods: This study is a post-hoc sub-study of the TTM trial, randomizing OHCA patients to a course of TTM at either 33°C or 36°C. Patients were included from sites participating in the TTMPLOS trial biobank sub study. NSE was measured at 24, 48 and 72 hours after ROSC and followup was concluded after 180 days. The primary end point was poor neurological function or death defined by a cerebral performance category score (CPC-score) of 3 to 5. Results: A total of 685 (73%) patients participated in the study. At day three after OHCA 63 (9%) patients had died and 473 (69%) patients were not awake. In these patients, a single NSE measurement at 48 hours predicted poor outcome with an area under the receiver operating characteristics curve (AUC) of 0.83. A combination of all three NSE measurements yielded the highest discovered AUC (0.88, p = .0002). Easily applicable combinations of serial NSE measurements did not significantly improve prediction over a single measurement at 48 hours (AUC 0.58-0.84 versus 0.83). Conclusion: NSE is a strong predictor of poor outcome after OHCA in persistently unconscious patients undergoing TTM, and NSE is a promising surrogate marker of outcome in clinical trials. While combinations of serial NSE measurements may provide an increase in overall prognostic information, it is unclear whether actual clinical prognostication with low false-positive rates is improved by application of serial measurements in persistently unconscious patients. The findings of this study should be confirmed in another prospective cohort.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
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- ref (subject category)
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Wiberg, Sebastia ...
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Hassager, Christ ...
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Stammet, Pascal
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Winther-Jensen, ...
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Thomsen, Jakob H ...
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Erlinge, David
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Wanscher, Michae ...
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Nielsen, Niklas
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Pellis, Tommaso
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Åneman, Anders
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Friberg, Hans
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Hovdenes, Jan
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Horn, Janneke
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Wetterslev, Jørn
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Bro-Jeppesen, Jo ...
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Wise, Matthew P
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Kuiper, Michael
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Cronberg, Tobias
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Gasche, Yvan
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Devaux, Yvan
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Kjaergaard, Jesp ...
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PLoS ONE
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Lund University