Are serial neuron-specific enolase levels associated with neurologic outcome of ECPR patients: A retrospective multicenter observational study

초록

Aim of the study: This study aims to evaluate whether neuron-specific enolase (NSE) level at 48 h after extracor-poreal cardiopulmonary resuscitation (ECPR) is associated with neurologic outcomes at 6 months after hospital discharge.Methods: This was a retrospective, multicenter, observational study of adult patients who received ECPR between May 2010 and December 2016. In the two hospitals involved in this study, NSE measurements were a routine part of the protocol for patients who received ECPR. Serial NSE levels were measured in all patients with ECPR. NSE levels were measured 24, 48, and 72 h after ECPR. The primary outcome was Cerebral Performance Catego-ries (CPC) scale at 6 months after hospital discharge according to NSE levels at 48 h after ECPR.Results: At follow-up 6 months after hospital discharge, favorable neurologic outcomes of CPC 1 or 2 were ob-served in 9 (36.0%) of the 25 patients, and poor neurologic outcomes of CPC 3, 4, or 5 were observed in 16 (64%) patients. NSE levels at 24 h in the favorable and poor neurologic outcome groups were 58.3 (52.5-73.2) j.ig/L and 64.2 (37.9-89.8) j.ig/L, respectively (p = 0.95). NSE levels at 48 h in the favorable and poor neurologic outcome groups were 52.1 (22.3-64.9) j.ig/L and 302.0 (62.8-360.2) j.ig/L, respectively (p = 0.01). NSE levels at 72 h were 37.2 (12.5-53.2) j.ig/L and 240.9 (75.3-370.0) j.ig/L, respectively (p < 0.01). In receiver operating char-acteristic (ROC) curve analysis, as the predictor of poor outcome, the optimal cut-off value for NSE level at 48 h was 140.5 j.ig/L, and the area under the curve (AUC) was 0.844 (p < 0.01). The optimal cut-off NSE level at 72 h was 53.2 j.ig/L, and the AUC was 0.897 (p < 0.01).Conclusions: NSE level at 72 h displayed the highest association with neurologic outcome after ECPR, and NSE level at 48 h was also associated with neurologic outcome after ECPR.(c) 2023 Published by Elsevier Inc.

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