Predictive power of serum NSE and OHCA score regarding 6-month neurologic outcome after out-of-hospital ventricular fibrillation and therapeutic hypothermia

Aim of the study: To determine the predictive power of the out-of-hospital cardiac arrest (OHCA) score and serum neuron-specific enolase (NSE) in patients resuscitated from ventricular fibrillation treated with therapeutic hypothermia (TH) and glucose control. Methods: An analysis of prospectively collected data of 90 TH patients. Serum NSE was measured at 24 and 48 h. Outcome was measured by neurologic exam 6 months after cardiac arrest with good Outcome defined as a Cerebral Performance Category (CPC) of 1 or 2. Results: In multiple logistic regression analysis, age (odds ratio [OR], 95% confidence interval 1.1 [1.03-1.18]/year), NSE at 48 h (OR 1.1 [1.02-1.26]/mu g/l), and increase in NSE levels (OR 7.2 [1.7-31.3]) were predictors of poor outcome, but the OHCA score was not. Cut-off points with 100% specificity in predicting poor outcome were 33 mu g/l for NSE at 48 h (sensitivity 43% [28-60%]) and 6.4 mu g/l for delta NSE 24-48 h (sensitivity 44% [28-60%]). Conclusion: Increase in NSE between 24 and 48 h and NSE at 48 h is specific but only moderately sensitive markers of 6-month outcome. Outcome prediction at ICU admission using the CHCA score was not possible in this selected patient population. (c) 2008 Elsevier Ireland Ltd. All rights reserved.