High levels of neuron-specific enolase after CPR and good clinical outcome

摘要

Recent studies have suggested that neuron-specific enolase (NSE) is a helpful predictor of outcome for initially comatose patients after cardiopulmonary resuscitation (CPR), particularly in the case of poor outcomes. To avoid withdrawal of support in patients who have a plausible chance of recovery, it is essential that such a test has a near zero rate of false positives for determining a poor prognosis.From data determined in 227 unconscious patients after CPR it was concluded that peak serum NSE concentration exceeding 80 ngml"1 is a highly specific but only moderately sensitive marker for a poor neurological outcome.2 In another prospective, multicenter study, an NSE level of more than 33 ngml"1, sampled between 1 and 3 days after cardiac arrest in 231 patients, was strongly predictive of a poor outcome with no false positives.We challenge the reliability of these cut-off values because we recently encountered two patients after CPR who recovered with good neurological outcome despite a maximal NSE concentration of 72 ngml~1 and 98 ngml"1, respectively (NSE enzyme immunoassay kit, Roche Molecular Biochemicals, Mannheim, Germany) (Fig. 1).