Author + information
- Rodolfo San Antonio Dharandas,
- Gustavo Jimenez,
- Eduardo Flores,
- Gala Caixal,
- Guillem Caldentey,
- Marco Hernandez Enriquez,
- Paula Sanchez Somonte,
- Xavier Freixa,
- Monica Masotti and
- Manel Sabate
Background: Several biomarkers of brain damage, particularly neuron-specific enolase (NSE), have been used to evaluate neurological outcome in out-of-hospital cardiac arrest (OHCA). In patients not undergoing therapeutic hypothermia (TH), previous studies have proposed a cutoff value of 33 ng/ml at 48 hours. The aim of this study is to investigate the role of NSE as early neurological prognostic marker (within 72 hours after OHCA) in patients undergoing TH, compared to other methods (EEG, somatosensory evoked potentials (SSEPs), as well as establish useful cut-off points in this set of patients.
Methods: Study involving 82 comatose patients (2011-16), treated with mild TH (33°C) after an OHCA. Neurological status at discharge was evaluated according to the Cerebral Performance Categories scale (CPC). 51 patients had good neurologic status (CPC 1-2), while 31 suffered serious sequelae (CPC 3-5). NSE levels were measured at 24, 48 and 72 hours. During the first 72 hours, EEG and SSEPs were also performed.
Results: There were no significant differences with respect to age, sex or etiology of OHCA between patients with good and poor neurological outcome. Nonshockable rhythms (86% in CPC 1-2 vs 67,7% in CPC 3-5, p 0,04) and higher initial lactate levels (26,9 +/- 21 vs 51,9 +/- 31, p <0,001) were predictors of poor neurological outcome. Absence of bilateral response was obtained in 15% of patients by SSEPs, consistent with poor prognosis (PPV 100%). However, the NPV was only 71%. The EEG was good predictor in patients with normal EEG (NPV 100%) and status epilepticus (PPV 91%). However, the EEG findings were conditioned by the use of sedation in early stages (PPV overall 41%). The area under the curve (AUC) determined a high predictive power of NSE peak (NSEp) with respect to CPC (AUC 0,937). A NSEp < 33 ng/ml (< 4% FN) and a NSEp > 58.5 ng/ml (< 4% FP), allowed to classify 67% of patients, reliable and early, to good and poor prognosis respectively.
Conclusions: In patients undergoing TH, in post-cardiac arrest syndrome, NSE seems the best early predictor of neurological outcome. However, prior to the generalization of cutoff values, it is still needed the standardization of measurement methods between different centers.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-320
- 2017 American College of Cardiology Foundation