한빛사논문
- 조회561
Youn‑Jung Kim1, Yong Hwan Kim2, Chun Song Youn3, In Soo Cho4, Su Jin Kim5, Jung Hee Wee6, Yoo Seok Park7, Joo Suk Oh8, Byung Kook Lee9 and Won Young Kim1*
1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic‑ro 43‑gil, Songpa‑gu, Seoul 05505, Korea.
2Departments of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
3Department of Emergency Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
4Department of Emergency Medicine, Hanil General Hospital, Seoul, Korea.
5Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea.
6Department of Emergency Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
7Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
8Department of Emergency Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu‑si, Korea.
9Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
*Correspondence: Won Young Kim
Abstract
Background: Serum neuron-specific enolase (NSE) is the only recommended biomarker for multimodal prognostication in postcardiac arrest patients, but low sensitivity of absolute NSE threshold limits its utility. This study aimed to evaluate the prognostic performance of serum NSE for poor neurologic outcome in out-of-hospital cardiac arrest (OHCA) survivors based on their initial rhythm and to determine the NSE cutoff values with false positive rate (FPR) < 1% for each group.
Methods: This study included OHCA survivors who received targeted temperature management (TTM) and had serum NSE levels measured at 48 h after return of spontaneous circulation in the Korean Hypothermia Network, a prospective multicenter registry from 22 university-affiliated teaching hospitals in South Korea between October 2015 and December 2018. The primary outcome was poor outcome at 6 month, defined as a cerebral performance category of 3-5.
Results: Of 623 patients who underwent TTM with NSE measured 48 h after the return of spontaneous circulation, 245 had an initial shockable rhythm. Median NSE level was significantly higher in the non-shockable group than in the shockable group (104.6 [40.6-228.4] vs. 25.9 [16.7-53.4] ng/mL, P < 0.001). Prognostic performance of NSE assessed by area under the receiver operating characteristic curve to predict poor outcome was significantly higher in the non-shockable group than in the shockable group (0.92 vs 0.86). NSE cutoff values with an FPR < 1% in the non-shockable and shockable groups were 69.3 (sensitivity of 42.1%) and 102.7 ng/mL (sensitivity of 76%), respectively.
Conclusion: NSE prognostic performance and its cutoff values with FPR < 1% for predicting poor outcome in OHCA survivors who underwent TTM differed between shockable and non-shockable rhythms, suggesting postcardiac arrest survivor heterogeneity.
논문정보
- Research article
- 2023년 08월 (BRIC 등록일 2023-08-14)
- 국내 연구진
- 의약학 > 응용의학
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