• Tanja Luescher, Jonas Mueller, Cyril Isenschmid, Jeanice Kalt, Roshaani Rasiah, Theresa Tondorf, Martina Gamp, Christoph Becker, Raoul Sutter, Kai Tisljar, Philipp Schuetz, Stephan Marsch, and Sabina Hunziker.
• Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland.
• Resuscitation. 2019 Sep 1; 142: 50-60.

AimNeuron-specific enolase (NSE) increases in response to brain injury and is recommended for outcome prediction in cardiac arrest patients. Our aim was to investigate whether NSE measured at different days after a cardiac arrest and its kinetics would improve the prognostic ability of two cardiac arrest specific risk scores.MethodsWithin this prospective observational study, we included consecutive adult patients after cardiac arrest. We calculated the Out-of-hospital cardiac arrest (OHCA) score and the Cardiac Arrest Hospital Prognosis (CAHP) score upon ICU admission and measured serum NSE upon admission and days 1, 2, 3, 5 and 7. We calculated logistic regression models to study associations of scores and NSE levels with neurological outcome defined by Cerebral Performance Category (CPC) scale and in-hospital death.ResultsFrom 336 included patients, 180 (54%) survived until hospital discharge, of which 150 (45%) had a good neurological outcome. NSE at day 3 showed the highest prognostic accuracy (discrimination) for neurological outcome (area under the curve (AUC) 0.89) and in-hospital mortality (AUC 0.88). These results were robust in reclassification statistics and across different subgroups. NSE kinetics with admission levels serving as a baseline did not further improve prognostication. NSE on day 3 significantly improved discrimination of both clinical risk scores (CAHP from AUC 0.81 to 0.91; OHCA from AUC 0.79 to 0.89).ConclusionNSE measured at day 3 significantly improves clinical risk scores for outcome prediction in cardiac arrest patients and may thus add to clinical decision making about escalation or withdrawal of therapy in this vulnerable patient population.Copyright © 2019 Elsevier B.V. All rights reserved.

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