Highlights
- •The NSE ratio is a unique method to quantify NSE changes over time.
- •NSE ratio > 1.0 indicates increasing NSE and may reflect ongoing neuronal injury.
- •A 48:24 h NSE ratio >1.7 was 100% specific for poor outcome in this population.
- •The NSE ratio may be generalizable across populations and laboratories.
Abstract
Introduction
Serum neuron-specific enolase (NSE) levels have been shown to correlate with neurologic
outcome in comatose survivors of cardiac arrest but use of absolute NSE thresholds
is limited. This study describes and evaluates a novel approach to analyzing NSE,
the NSE ratio, and evaluates the prognostic utility of NSE absolute value thresholds
and trends over time.
Methods
100 consecutive adult comatose cardiac arrest survivors were prospectively enrolled.
NSE levels were assessed at 24, 48, and 72 h post-arrest. Primary outcome was the
Glasgow Outcome Score (GOS) at 6 months post-arrest; good outcome was defined as GOS
3–5. Absolute and relative NSE values (i.e. the NSE ratio), peak values, and the trend
in NSE over 72 h were analyzed.
Results
98 patients were included. 42 (43%) had a good outcome. Five good outcome patients
had peak NSE >33 µg/L (34.9–46.4 µg/L). NSE trends between 24 and 48 h differed between
outcome groups (decrease by 3.0 µg/L (0.9–7.0 µg/L) vs. increase by 13.4 µg/L (−3.7
to 69.4 µg/L), good vs. poor, p = 0.004). The 48:24 h NSE ratio differed between the
good and poor outcome groups (0.8 (0.6–0.9) vs. 1.4 (0.8–2.5), p = 0.001), and a 48:24 h
ratio of ≥1.7 was 100% specific for poor outcome.
Conclusions
The NSE ratio is a unique method to quantify NSE changes over time. Values greater
than 1.0 indicate increasing NSE and may be reflective of ongoing neuronal injury.
The NSE ratio obviates the need for an absolute value cut-off.
Keywords
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Article info
Publication history
Published online: August 22, 2018
Accepted:
August 13,
2018
Received:
April 13,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
