Biomarkers for neuroprognostication after out-of-hospital cardiac arrest

Isse, Yusuf Abdi; Meyer, Mechthild; Hassager, Christian

doi:10.1093/ehjacc/zuad056

Cited by 1 publication

(2 citation statements)

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“…Currently, NSE values are only adjusted among samples with a high haemolysis index at the corresponding timepoint, however, early haemolysis associated with cardiac arrest is not taken into account, which may affect the serum concentration of NSE. 13 Our results show that patients with a high admission free-hgb had a higher NSE at 48 h, but a higher mortality rate or an increased incidence of poor neurological outcome were not observed in this group. This might indicate that the slightly increased NSE concentration was driven by destructed red blood cells during OHCA, which can be explained by the longer time to ROSC.…”

Section: Discussionmentioning

confidence: 44%

“… 12 Potentially, NSE might be elevated at 48 h due to release from destructed red blood cells during resuscitation. 13 Therefore, it is essential to investigate if early haemolysis has an impact on the interpretation of NSE. Yet, no studies have routinely measured early haemolysis among OHCA patients and determined its impact on later NSE measurements.…”

Section: Introductionmentioning

confidence: 99%

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Predicting poor neurological outcomes following out-of-hospital cardiac arrest using neuron-specific enolase and neurofilament light chain in patients with and without haemolysis

Abdi Isse,

Frikke-Schmidt,

Wiberg

et al. 2023

European Heart Journal Open

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Aims Hypoxic-ischaemic brain injury following out-of-hospital cardiac arrest (OHCA) is a common complication and a major cause of death. Neuron-specific enolase (NSE) and neurofilament light chain (NfL) are released after brain injury and elevated concentrations of both are associated with poor neurological outcome. We explored the influence of haemolysis on the prognostic performance of NSE and NfL. Methods and results The study is based on post hoc analyses of a randomized, single-centre, double-blinded, controlled trial (IMICA), where comatose OHCA patients of presumed cardiac cause were included. Free-haemoglobin was measured at admission to quantify haemolysis. NSE and NfL were measured after 48 h to estimate the extent of brain injury. Montreal Cognitive Assessment score (MoCA) was assessed to evaluate neurocognitive impairments. Seventy-three patients were included and divided into two groups by the median free-haemoglobin at admission. No group differences in mortality or poor neurological outcome were observed. The high-admission free-haemoglobin group had a significantly higher concentration of NSE compared to the low-admission free-haemoglobin group (27.4 µmol/L vs. 19.6 µmol/L, P = 0.03), but no differences in NfL. The performance of NSE and NfL in predicting poor neurological outcome were high for both, but NfL was numerically higher [area under the ROC (AUROC) 0.90 vs. 0.96, P = 0.09]. Furthermore, NfL, but not NSE, was inversely correlated with MoCA score, R2 = 0.21, P = 0.006. Conclusion High free-haemoglobin at admission was associated with higher NSE concentration after 48 h, but, the performance of NSE and NfL in predicting poor neurological outcome among OHCA patients were good regardless of early haemolysis. Only elevated NfL concentrations were associated with cognitive impairments.

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Section: Discussionmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%