• W Fogel, D Krieger, M Veith, H P Adams, E Hund, B Storch-Hagenlocher, F Buggle, D Mathias, and W Hacke.
• Department of Neurology, Heidelberg University, Germany.
• Crit. Care Med. 1997 Jul 1;25(7):1133-8.

ObjectiveTo examine the prognostic value of serum neuron-specific enolase for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiac arrest.DesignProspective study.SettingCoronary intensive care unit of the University of Heidelberg.PatientsForty-three patients (66.8 +/- 12.7 [SD] yrs, range 33 to 85) who had had either primary or secondary cardiac arrest, followed by cardiopulmonary resuscitation (CPR).InterventionsSerial blood samples and clinical examinations.Measurements And Main ResultsSerum neuron-specific enolase concentrations were determined after CPR on 7 consecutive days. Twenty-five patients remained comatose and subsequently died; 18 patients survived the first 3 months and had no relevant functional deficit at 3-month follow-up. Neuron-specific enolase concentrations were correlated with neurologic outcome. Concentrations of >33 ng/mL predicted persistent coma with a high specificity (100%) and a positive predictive value of 100%. Overall sensitivity was 80%, with a negative predictive value of 78%. Serum concentrations of neuron-specific enolase exceeded this cutoff value no more than 3 days after cardiac arrest in 95% of patients in whom these concentrations had exceeded 33 ng/mL.ConclusionsIn patients who have been resuscitated after cardiac arrest, serum neuron-specific enolase concentrations of >33 ng/mL predict persistent coma with a high specificity. Values below this cutoff level do not necessarily indicate complete recovery, because this method has a sensitivity of 80%.

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