Neuron-specific enolase correlates with other prognostic markers after cardiac arrest

Abstract

Cronberg et al.1 reported serum NSE levels >33 μg/L to be highly predictive of death after CA treated with hypothermia, and to correlate with abnormal diffusion-weighted imaging (DWI), abnormal somatosensory evoked potentials (SSEP), and postmortem brain histology. The accompanying editorial by Mayer2 implied that tests like NSE are needed more than ever because hypothermia has fundamentally changed the way post-CA prognosis is determined. However, while the game may have changed, the rules are still the same. While hypothermia increases the proportion of patients with CA who regain consciousness, those who do not after 72 hours still have a uniformly poor prognosis. Rather than trying to predict who will die, the more clinically relevant task is to identify the few who are destined to survive. In that case, NSE sensitivity, not its specificity, is the important characteristic to consider. Unfortunately, NSE sensitivity, and its ability to rule out the possibility of death, is considerably less robust. This may …