Background: Neuron specific enolase (NSE) has repeatedly been evaluated for neurological prognostication in\r\npatients after cardiac arrest. However, it is unclear whether current guidelines for NSE cutoff levels also apply to\r\ncardiac arrest patients treated with hypothermia. Thus, we investigated the prognostic significance of absolute NSE\r\nlevels and NSE kinetics in cardiac arrest patients treated with hypothermia.\r\nMethods: In a prospective study of 35 patients resuscitated from cardiac arrest, NSE was measured daily for four\r\ndays following admission. Outcome was assessed at ICU discharge using the CPC score. All patients received\r\nhypothermia treatment for 24 hours at 33�°C with a surface cooling device according to current guidelines.\r\nResults: The cutoff for absolute NSE levels in patients with unfavourable outcome (CPC 3-5) 72 hours after cardiac\r\narrest was 57 �µg/l with an area under the curve (AUC) of 0.82 (sensitivity 47%, specificity 100%). The cutoff level for\r\nNSE kinetics in patients with unfavourable outcome (CPC 3-5) was an absolute increase of 7.9 �µg/l (AUC 0.78,\r\nsensitivity 63%, specificity 100%) and a relative increase of 33.1% (AUC 0.803, sensitivity 67%, specificity 100%) at 48\r\nhours compared to admission.\r\nConclusion: In cardiac arrest patients treated with hypothermia, prognostication of unfavourable outcome by NSE\r\nkinetics between admission and 48 hours after resuscitation may be superior to prognostication by absolute NSE\r\nlevels.
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