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European Heart Journal Advance Access originally published online on October 23, 2006
European Heart Journal 2007 28(1):52-58; doi:10.1093/eurheartj/ehl316
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prediction of neurological outcome after cardiopulmonary resuscitation by serial determination of serum neuron-specific enolase

Johann Reisinger1,*, Kurt Höllinger1, Wolfgang Lang1, Christoph Steiner1, Thomas Winter1, Eduard Zeindlhofer1, Michael Mori1, Alexandra Schiller1, Alexander Lindorfer1, Kurt Wiesinger2 and Peter Siostrzonek1

1 Department of Internal Medicine/Cardiology, Krankenhaus Barmherzige Schwestern, Seilerstätte 4, 4010 Linz, Austria
2 Department of Laboratory Medicine, Krankenhaus Barmherzige Schwestern, Linz, Austria

Received 1 May 2006; revised 22 September 2006; accepted 28 September 2006; online publish-ahead-of-print 23 October 2006.

* Corresponding author. Tel: +43 732 7677 7202; fax: +43 732 7677 7414. E-mail address: johann.reisinger{at}bhs.at

See page 1 for the editorial comment on this article (doi:10.1093/eurheartj/ehl397)

Aims Data on the diagnostic accuracy of neuron-specific enolase (NSE) as marker of hypoxic brain damage are conflicting. The purpose of this prospective observational cohort study was to explore the prognostic value of serum NSE after cardiopulmonary resuscitation (CPR) and to define the most sensitive cutoff value with a specificity of 100% for the prediction of persistent coma.

Methods and results Serum NSE concentrations were serially determined in 227 consecutive unconscious patients after CPR who were classified according to the best Glasgow–Pittsburgh cerebral performance categories (CPC, 1–4) achieved within 6 months follow-up. Sixteen patients were excluded due to incomplete NSE data and 34 due to death under analgesia sedation. The prevalence of poor neurological outcome (persistent coma, CPC 4) in our 177 analysed patients was 33%. At a specificity of 100%, a peak NSE concentration above 80 ng/mL predicted persistent coma with a sensitivity of 63%, a positive predictive value of 100%, a negative predictive value of 84%, and a predictive accuracy of 88%.

Conclusion A peak serum NSE concentration exceeding 80 ng/mL is a highly specific but only moderately sensitive marker for a poor neurological outcome after CPR.

Key Words: Cardiopulmonary resuscitation • Neuron-specific enolase • Neurological outcome


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