Combined estimation of Plasma Cell-free DNA level and Neuron Specific Enolase as Outcome Predictors of Post-resuscitation Patients

Abstract

Objectives: To evaluate the prognostic yield of estimation of plasma cell-free DNA and neuron specific enolase (NSE) levels in post-resuscitation patients concerning survival and neurologic outcome in comparison to Cerebral Performance Category (CPC) score. Patients & Methods: The study included 80 patients developed out-ofhospital cardiac arrest. All patients received mild therapeutic hypothermia irrespective of the initial rhythm. Blood samples were drawn at study inclusion for estimation of plasma cell-free DNA and serum NSE. Mortality rate was determined 1-week and 1-month after admission. Neurologic outcomes were evaluated using CPC score collectively as CPC score of 1-2 indicted favorable neurological outcome. Results: 1-week mortality rate was 20% and throughout a mean ICU stay of 18.4±10.1; range: 3-42 days, another 17 patients died for late mortality rate of 21.3% and a total mortality rate of 46.3%. At time of discharge 31 patients (38.8%) were CPC1-2 (Favorable outcome), while 12 patients (14.9%) were CPC-3 (Unfavorable outcome). Mean plasma DNA and serum NSE levels were significantly higher in CPC3 patients compared to CPC1-2 patients. Survivors had significantly lower at admission plasma cell-free DNA and non-significantly lower serum NSE compared to non-survivors. Survivors had favorable outcome had significantly lower at admission plasma cell-free DNA and serum NSE compared to those had unfavorable neurologic outcome. There was positive significant correlation between plasma cell-free DNA and serum NSE levels and mortality and unfavorable outcome rates. However, the correlation was more significant with plasma DNA than with serum NSE. ROC curve analysis found elevated levels of both parameters could significantly predict the unfavorable neurologic outcome, while high plasma cell-free DNA could significantly predict high mortality rate. Conclusion: At admission plasma levels of cell-free DNA and serum NSE act synergically for prediction of survival and neurologic outcome of postresuscitation patients.