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Cited 4 time in webofscience Cited 4 time in scopus
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Different neuroprognostication thresholds of neuron-specific enolase in shockable and non-shockable out-of-hospital cardiac arrest: a prospective multicenter observational study in Korea (the KORHN-PRO registry)open access

Authors
Kim, Youn-JungKim, Yong HwanYoun, Chun SongCho, In SooKim, Su JinWee, Jung HeePark, Yoo SeokOh, Joo SukLee, Byung KookKim, Won Young
Issue Date
Aug-2023
Publisher
BioMed Central
Keywords
Out-of-hospital cardiac arrest; Neuron-specific enolase; Shockable rhythm; Non-shockable rhythm; Prognosis
Citation
Critical Care, v.27, no.1
Indexed
SCIE
SCOPUS
Journal Title
Critical Care
Volume
27
Number
1
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/63980
DOI
10.1186/s13054-023-04603-6
ISSN
1466-609X
1364-8535
Abstract
Background Serum neuron-specific enolase (NSE) is the only recommended biomarker for multimodal prognostication in postcardiac arrest patients, but low sensitivity of absolute NSE threshold limits its utility. This study aimed to evaluate the prognostic performance of serum NSE for poor neurologic outcome in out-of-hospital cardiac arrest (OHCA) survivors based on their initial rhythm and to determine the NSE cutoff values with false positive rate (FPR) < 1% for each group. Methods This study included OHCA survivors who received targeted temperature management (TTM) and had serum NSE levels measured at 48 h after return of spontaneous circulation in the Korean Hypothermia Network, a prospective multicenter registry from 22 university-affiliated teaching hospitals in South Korea between October 2015 and December 2018. The primary outcome was poor outcome at 6 month, defined as a cerebral performance category of 3-5. Results Of 623 patients who underwent TTM with NSE measured 48 h after the return of spontaneous circulation, 245 had an initial shockable rhythm. Median NSE level was significantly higher in the non-shockable group than in the shockable group (104.6 [40.6-228.4] vs. 25.9 [16.7-53.4] ng/mL, P < 0.001). Prognostic performance of NSE assessed by area under the receiver operating characteristic curve to predict poor outcome was significantly higher in the non-shockable group than in the shockable group (0.92 vs 0.86). NSE cutoff values with an FPR < 1% in the non-shockable and shockable groups were 69.3 (sensitivity of 42.1%) and 102.7 ng/mL (sensitivity of 76%), respectively. Conclusion NSE prognostic performance and its cutoff values with FPR < 1% for predicting poor outcome in OHCA survivors who underwent TTM differed between shockable and non-shockable rhythms, suggesting postcardiac arrest survivor heterogeneity.
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