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| Prognostic value of continuous NSE monitoring in the neurological outcome of the patients with mild hypothermia after cardiac arrest |
| Zhao Shan-shan, Jin Zhao-chen, Li Yong, Du Qi-guang, Wang Chun |
| Department of Critical Care Medicine, the Affiliated People′s Hospital of Jiangsu University, Jiangsu 212002, China |
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Abstract Objective To determine whether continuous neuron specific enolase (NSE) monitoring can predict the short-term and long-term neurological prognosis of the patients with mild hypothermia therapy(MHT) after cardiac arrest(CA). Methods A prospective study from June 2013 to November 2017 was conducted, while the patients who underwent CA with the return of spontaneous circulation and being treated with MHT in the ICU of the First People′s Hospital of Zhenjiang were selected, and the total number was 130. We collected the general clinical data, and monitored NSE values on the 1st, 2nd, 3rd, 4th day, neural function of the 30th day and 6th month was also observed. The patients were divided into four groups according to the Cerebral Performance Category (CPC): CPC 1～2 on the 30th day was classified as group A, CPC 3～5 on the 30th day as group B, while CPC 1～2 in the 6th month as group C and CPC 3～5 in the 6th month as group D. We compared group A and B, group C and D about NSE values on all time points and in order to find whether there was correlation between daily NSE value and short-term or long-term prognosis at the same time by using ROC curve analysis. Results ①Comparing group A and B, the general clinical data such as gender, age, cause of CA, the rhythm of the heart before cardiac arrest, APACHE Ⅱ score, initial lactic acid level, did not show statistical significances between the two groups, and neither did the results between group C and D (P>0.05). ②The NSE value of group A was (60.32±14.00) ng/mL on the first day, that of group B was (69.04±20.91) ng/mL; the NSE value of group A was (84.63±9.01) ng/mL on the second day, and that of group B was (101.65±15.07) ng/mL; the NSE value of group A was (57.35±13.03)ng/mL on the third day, that of group B was (72.51±6.85) ng/mL; and the NSE value of group A was (48.84±12.34) ng/mL on the fourth day, that of group B was (62.73±12.03) ng/mL，NSE levels on all time points in group A were significantly lower than that in group B (P<0.05). On the first day, the NSE value of group C was (57.66±10.13) ng/ml, that of group D was (68.51±20.66) ng/mL; the NSE value of group C was (85.41±9.08) ng/mL on the second day, and that of group D was(97.3015.98) ng/mL; while the NSE value of group C was (56.26±11.81)ng/mL on the third day, that of group D was (66.79±14.17) ng/mL; and the NSE value of group C was (48.81±10.92) ng/mL on the fourth day, and that of group D was (57.43±12.60) ng/mL, the NSE levels on all time points in group C were also significantly lower than that in group D (P<0.05). ③ Through the ROC curve analysis, the predicted value of CPC on the 30th day, the area under the ROC curve (AUC) of the 1st day was 0.624 (P<0.05); the AUC of the 2nd day was 0.903 (P<0.001); while the AUC of the 3rd day was 0.920 (P<0.001) and the AUC of the 4th day was 0.905 (P<0.001). The NSE levels can also be used to predict the prognosis of neuro function on the 6th month through the ROC curve analysis. The AUC on the 1st day was 0.651 (P<0.05); the AUC of the 2nd day was 0.773 (P<0.001); the AUC of the 3rd day was 0.798 (P<0.001) and the AUC of the 4th day was 0.788(P<0.001). Conclusion NSE can predict short-term and long-term neurological prognosis in the patients with MHT after CA.
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Corresponding Authors:
Jin Zhao-chen, E-mail: jinzc57@163.com
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