Abstract 205: Vadilation Of Neuron-specific Enolase In Cardiac Arrest Patients And Association Factors For Neurological Outcomes In The Subgroup Of Negative Neuron-specific Enolase

Abstract

Aim: Neuron-specific enolase (NSE) alone has limitations in prognostication in cardiac arrest survivors, like other tools. To avoid early withdrawal of life-sustaining therapy, we verified the prognostic performance according to the reference value of NSE and investigated the variables related to the neurological outcomes in the patients with negative NSE. Methods: We performed a retrospective analysis of data from adult cardiac arrest survivors who underwent targeted temperature management at a university-affiliated hospital between January 2014 and December 2020. We measured the NSE level 48 hr after the return of spontaneous circulation. We performed receiver operating characteristics (ROC) and used the reference value of NSE (< 17 μg/L), the Youden index indicated NSE, and European Resuscitation Council (ERC) suggested NSE value (< 60 μg/L) as a threshold. We performed a multivariable logistic regression analysis to investigate the independent factors associated with true negative versus false negative for NSE cutoff. The primary outcome was 6-month neurological outcomes with Cerebral Performance Category (CPC), dichotomized into good (CPC 1 or 2) or poor (CPC 3-5) neurologic outcomes. Results: Of the 522 included patients, 355 (68.0%) patients had poor neurological outcomes. The area under ROC of NSE was 0.887 (95% confidence intervals [CIs], 0.856-0.913; p < 0.001) with Youden index value of 35.6 μg/L. Analyses with specific cutoff values of 17 μg/L, 35.6 μg/L, and 60 μg/L showed a sensitivity of 86.8%, 72.4%, and 58.0% with a specificity of 66.5%, 93.4%, and 98.8%, respectively. In the patients with NSE < 60 μg/L, younger age (odd ratio [OR], 0.954 [95% CIs, 0.934-0.976]), witness of collapse (OR, 3.520 [95% CIs, 1.625-7.626]) shockable rhythm (OR, 5.953 [95% CIs, 2.879-12.308]), cardiac etiology (OR, 2.796 [95% CIs, 1.444-5.416]), and lower sequential organ failure assessment (SOFA) (OR, 0.823 [95% CIs, 0.744-0.912]) were independently associated with true negative group rather than false negative group. Conclusions: NSE < 60 μg/L had less than 2% false-positive rate. Younger age, a witness of collapse, shockable rhythm, cardiac etiology, and lower SOFA were associated with good neurological outcomes in the negative NSE group.