April 20, 2026Journal of the American College of Cardiology334 citations
View Full PaperNeuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C
Key Result
Neuron-specific enolase (NSE) levels at 48 and 72 hours strongly predicted poor neurological outcome at 6 months after out-of-hospital cardiac arrest (AUC 0.85 and 0.86, respectively).
Key Points
- To examine the effectiveness of neuron-specific enolase as a prognostic marker for neurological outcomes in patients after out-of-hospital cardiac arrest.
- Randomized trial involving 686 patients hospitalized post-OHCA
- Patients received targeted temperature management at either 33°C or 36°C
- NSE levels assessed at 24, 48, and 72 hours post-return of spontaneous circulation.
- NSE predicted neurological outcomes with median values of 18 ng/ml vs 35 ng/ml (24 h), 15 ng/ml vs 61 ng/ml (48 h), and 12 ng/ml vs 54 ng/ml (72 h), p < 0.001.
- Areas under the receiver-operating curve for NSE at 48 and 72 hours were 0.85 and 0.86 respectively.
- Target temperature (33°C or 36°C) did not significantly affect NSE values.
Study Design
Type
RCT (n=686)
Randomization
randomized
Structured PICO
Does neuron-specific enolase (NSE) predict neurological outcome in patients hospitalized after out-of-hospital cardiac arrest?
P
Population
686 patients hospitalized after out-of-hospital cardiac arrest (OHCA)
I
Intervention
Measurement of Neuron-specific enolase (NSE) levels at 24, 48, and 72 hours after return of spontaneous circulation
O
Outcome
Neurological outcome at 6 months using the cerebral performance category scorehard clinical
High, serial NSE values are strong predictors of poor neurological outcome after out-of-hospital cardiac arrest, and these levels are not significantly affected by targeted temperature management at 33°C versus 36°C.
Main Result
Effect estimate: AUC 0.86
p-value: p=<0.001
Abstract
BACKGROUND: Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. OBJECTIVES: This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. METHODS: A total of 686 patients hospitalized after OHCA were randomized to targeted temperature management at either 33°C or 36°C. NSE levels were assessed in blood samples obtained 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was neurological outcome at 6 months using the cerebral performance category score. RESULTS: NSE was a robust predictor of neurological outcome in a baseline variable-adjusted model, and target temperature did not significantly affect NSE values. Median NSE values were 18 ng/ml versus 35 ng/ml, 15 ng/ml versus 61 ng/ml, and 12 ng/ml versus 54 ng/ml for good versus poor outcome at 24, 48, and 72 h, respectively (p < 0.001). At 48 and 72 h, NSE predicted neurological outcome with areas under the receiver-operating curve of 0.85 and 0.86, respectively. High NSE cutoff values with false positive rates ≤5% and tight 95% confidence intervals were able to reliably predict outcome. CONCLUSIONS: High, serial NSE values are strong predictors of poor outcome after OHCA. Targeted temperature management at 33°C or 36°C does not significantly affect NSE levels. (Target Temperature Management After Cardiac Arrest TTM; NCT01020916).