{
    "abstract": "Prognostic markers of good neurological outcome after cardiac arrest (CA) remain limited. We aimed to evaluate the prognostic value of neuron-specific enolase (NSE), electroencephalogram (EEG) and somatosensory evoked potentials (SSEP) in predicting good outcome, assessed separately and in combination.\nA retrospective study was conducted in a tertiary CA center, using a prospective registry. We included all patients comatose after discontinuation of sedation and with one EEG and NSE blood measurement at 24, 48 or/and 72\u00a0h after CA. The primary outcome was favorable neurological outcome at three months, a Cerebral Performance Categories (CPC) scale 1-2 defining a good outcome.\nBetween January 2017 and April 2024, 215 patients were included. Participants were 63\u00a0years old (IQR [52-73]), and 73% were male. At 3\u00a0months, 54 patients (25.1%) had a good outcome. Compared to the poor outcome group, NSE blood levels were significantly lower in the good outcome group at 24\u00a0h (39 IQR[27-45] vs 54 IQR[37-82]\u00b5g/L, p\u2009<\u20090.001), 48\u00a0h (26 [18-43] vs 107 [54-227]\u00b5g/L, p\u2009<\u20090.001) and 72\u00a0h (20\u00a0\u00b5g/L IQR [15-30] vs 184\u00a0\u00b5g/l IQR [60-300], p\u2009<\u20090,001). Normal NSE (i.e.,\u2009<\u200917\u00a0\u00b5g/L) at 24\u00a0h was highly predictive of good outcome, with a predictive positive value (PPV) of 71% despite a sensitivity (Se) of 9%. The best cut-off values for NSE at 24, 48 and 72\u00a0h were below 45.5, 51.5 and 41.5\u00a0\u00b5g/L, yielding PPV of 64%, 80% and 83% and sensitivities of 74%, 93% and 90%, respectively. A decreasing trend in NSE levels between 24 and 72\u00a0h was also highly predictive of good outcome (PPV 82%, Se 81%). A benign EEG pattern was more frequently observed in the good outcome group (87.1 vs 14.9%, p\u2009<\u20090.001) and predicted a good outcome with a PPV of 72% and a Se of 94%. Regarding SSEPs, a bilateral N20-baseline amplitude\u2009>\u20090.85\u00a0\u00b5V was predictive of good outcome (PPV 75%, Se 100%). The combination of NSE\u2009<\u200951.5\u00a0\u00b5g/l at 48\u00a0h, a decreasing NSE trend between 24 and 72\u00a0h and a benign EEG showed the best predictive value (PPV 96%, Se 76%).\nIn comatose patients after CA, a low NSE levels at 24, 48\u00a0h or 72\u00a0h, a decreasing trend in NSE over time, a benign EEG and a high N20 amplitude are robust markers of favorable outcome, reducing prognosis uncertainty.",
    "authors": [
        {
            "affiliation": "Medical ICU, Cochin Hospital, Assistance Publique - H\u00f4pitaux de Paris (AP\u2011HP) AP-HP Centre Universit\u00e9 Paris Cit\u00e9, 27 Rue du Faubourg Saint\u2011Jacques, 75014, Paris, France.",
            "firstname": "Aur\u00e9lie",
            "initials": "A",
            "lastname": "Besnard"
        },
        {
            "affiliation": "Medical ICU, Cochin Hospital, Assistance Publique - H\u00f4pitaux de Paris (AP\u2011HP) AP-HP Centre Universit\u00e9 Paris Cit\u00e9, 27 Rue du Faubourg Saint\u2011Jacques, 75014, Paris, France.",
            "firstname": "Juliette",
            "initials": "J",
            "lastname": "Pelle"
        },
        {
            "affiliation": "University Paris Cit\u00e9 - Medical School, Paris, France.\nNeurophysiology and Epileptology Department, GHU Paris Psychiatry et Neurosciences, Sainte Anne Hospital, Paris, France.\nINSERM U1266, Institute of Psychiatry and Neuroscience of Paris (IPNP), Paris, France.",
            "firstname": "Estelle",
            "initials": "E",
            "lastname": "Pruvost-Robieux"
        },
        {
            "affiliation": "Clinical Chemistry Department, Cochin Hospital, AP-HP Paris Centre, Paris, France.",
            "firstname": "Antonin",
            "initials": "A",
            "lastname": "Ginguay"
        },
        {
            "affiliation": "Medical ICU, Cochin Hospital, Assistance Publique - H\u00f4pitaux de Paris (AP\u2011HP) AP-HP Centre Universit\u00e9 Paris Cit\u00e9, 27 Rue du Faubourg Saint\u2011Jacques, 75014, Paris, France.",
            "firstname": "Clara",
            "initials": "C",
            "lastname": "Vigneron"
        },
        {
            "affiliation": "Medical ICU, Cochin Hospital, Assistance Publique - H\u00f4pitaux de Paris (AP\u2011HP) AP-HP Centre Universit\u00e9 Paris Cit\u00e9, 27 Rue du Faubourg Saint\u2011Jacques, 75014, Paris, France.\nUniversity Paris Cit\u00e9 - Medical School, Paris, France.",
            "firstname": "Fr\u00e9d\u00e9ric",
            "initials": "F",
            "lastname": "P\u00e8ne"
        },
        {
            "affiliation": "Medical ICU, Cochin Hospital, Assistance Publique - H\u00f4pitaux de Paris (AP\u2011HP) AP-HP Centre Universit\u00e9 Paris Cit\u00e9, 27 Rue du Faubourg Saint\u2011Jacques, 75014, Paris, France.\nUniversity Paris Cit\u00e9 - Medical School, Paris, France.",
            "firstname": "Jean-Paul",
            "initials": "JP",
            "lastname": "Mira"
        },
        {
            "affiliation": "Medical ICU, Cochin Hospital, Assistance Publique - H\u00f4pitaux de Paris (AP\u2011HP) AP-HP Centre Universit\u00e9 Paris Cit\u00e9, 27 Rue du Faubourg Saint\u2011Jacques, 75014, Paris, France.\nUniversity Paris Cit\u00e9 - Medical School, Paris, France.\nAfter ROSC Network, Paris, France.",
            "firstname": "Alain",
            "initials": "A",
            "lastname": "Cariou"
        },
        {
            "affiliation": "Medical ICU, Cochin Hospital, Assistance Publique - H\u00f4pitaux de Paris (AP\u2011HP) AP-HP Centre Universit\u00e9 Paris Cit\u00e9, 27 Rue du Faubourg Saint\u2011Jacques, 75014, Paris, France. sarah.benghanem@aphp.fr.\nUniversity Paris Cit\u00e9 - Medical School, Paris, France. sarah.benghanem@aphp.fr.\nINSERM U1266, Institute of Psychiatry and Neuroscience of Paris (IPNP), Paris, France. sarah.benghanem@aphp.fr.\nAfter ROSC Network, Paris, France. sarah.benghanem@aphp.fr.",
            "firstname": "Sarah",
            "initials": "S",
            "lastname": "Benghanem"
        }
    ],
    "conclusions": "In comatose patients after CA, a low NSE levels at 24, 48\u00a0h or 72\u00a0h, a decreasing trend in NSE over time, a benign EEG and a high N20 amplitude are robust markers of favorable outcome, reducing prognosis uncertainty.",
    "copyrights": "\u00a9 2025. The Author(s).",
    "doi": "10.1186/s13054-025-05378-8",
    "journal": "Critical care (London, England)",
    "keywords": [
        "Cardiac arrest",
        "Coma",
        "EEG",
        "Electroencephalography",
        "NSE",
        "Neuron-specific enolase",
        "Neuroprognostication",
        "SSEP",
        "Somatosensory-evoked potentials"
    ],
    "methods": null,
    "publication_date": "2025-04-12",
    "pubmed_id": "40217465\n34705079\n32562686\n34454687\n33765189\n36949360\n37396931\n36623748\n39151721\n35244745\n38917136\n31215475\n36951448\n27291880\n34417831\n29175384\n20484098\n18064739\n15582757\n33475321\n25267568\n26865516\n24237006\n34133859\n35089409\n12421743\n27098348\n29555261\n26464395\n35290522\n31009028\n32915254\n35471582\n25940963\n31155751\n31211949\n36480063\n30071861\n36396011\n32687592\n33930503\n33819501\n32425878\n39821725\n35470143",
    "results": "Between January 2017 and April 2024, 215 patients were included. Participants were 63\u00a0years old (IQR [52-73]), and 73% were male. At 3\u00a0months, 54 patients (25.1%) had a good outcome. Compared to the poor outcome group, NSE blood levels were significantly lower in the good outcome group at 24\u00a0h (39 IQR[27-45] vs 54 IQR[37-82]\u00b5g/L, p\u2009<\u20090.001), 48\u00a0h (26 [18-43] vs 107 [54-227]\u00b5g/L, p\u2009<\u20090.001) and 72\u00a0h (20\u00a0\u00b5g/L IQR [15-30] vs 184\u00a0\u00b5g/l IQR [60-300], p\u2009<\u20090,001). Normal NSE (i.e.,\u2009<\u200917\u00a0\u00b5g/L) at 24\u00a0h was highly predictive of good outcome, with a predictive positive value (PPV) of 71% despite a sensitivity (Se) of 9%. The best cut-off values for NSE at 24, 48 and 72\u00a0h were below 45.5, 51.5 and 41.5\u00a0\u00b5g/L, yielding PPV of 64%, 80% and 83% and sensitivities of 74%, 93% and 90%, respectively. A decreasing trend in NSE levels between 24 and 72\u00a0h was also highly predictive of good outcome (PPV 82%, Se 81%). A benign EEG pattern was more frequently observed in the good outcome group (87.1 vs 14.9%, p\u2009<\u20090.001) and predicted a good outcome with a PPV of 72% and a Se of 94%. Regarding SSEPs, a bilateral N20-baseline amplitude\u2009>\u20090.85\u00a0\u00b5V was predictive of good outcome (PPV 75%, Se 100%). The combination of NSE\u2009<\u200951.5\u00a0\u00b5g/l at 48\u00a0h, a decreasing NSE trend between 24 and 72\u00a0h and a benign EEG showed the best predictive value (PPV 96%, Se 76%).",
    "title": "Multimodal assessment of favorable neurological outcome using NSE levels and kinetics, EEG and SSEP in comatose patients after cardiac arrest.",
    "xml": "<Element 'PubmedArticle' at 0x7885047f0d60>"
}