Abstract 15538: Serial Measurements of Neuron-specific Enolase and Prediction of Poor Neurological Outcome in Comatose Patients After Out-of-hospital Cardiac Arrest - A TTM Substudy

Abstract

Purpose: Neuron-specific enolase (NSE) has been established as a predictor of poor neurological outcome after out-of-hospital cardiac arrest (OHCA). The optimal strategy for evaluation of serial NSE measurements remains unknown. Methods: The Target Temperature Management (TTM) trial biobank holds serial blood samples of OHCA patients, drawn at 24 hours, 48 hours and 72 hours after randomization to targeted temperature of either 33°C or 36°C. We included all patients being comatose at day 3 and investigated the value of NSE to predict poor neurological outcome and death (i.e. cerebral performance category 3-5) at 180 days follow-up. Multiple logistical regression and C-statistics models were used to establish the optimal use of the NSE-values. Results: A total of 550 comatose OHCA patients were included in the study (mean age 65 years, 80% men). At 180-day follow-up 333 (61%) of the patients had a CPC-score of 3 to 5. C-statistics revealed that the strongest predictor for poor CPC-score was the NSE value at 72 hours (AUC=0.85, see table). In a multiple logistic regression model adjusted for sex, age, time to return of spontaneous circulation, shock-able rhythm and lactate-levels at admission the area under the NSE-curve from 24 to 72 hours had the highest odds ratio (OR=4.2, p<.0001). Conclusions: In patients being comatose at day three after OHCA the biomarker NSE is a strong predictor for poor neurological function and death (CPC 3-5) at 180-day follow-up. Adjustment for pre-hospital factors associated with a poor prognosis suggests that the area under the NSE-curve from 24 to 72 hours is a strong independent predictor.