Objectives: To evaluate the prognostic yield of estimation of plasma cell-free DNA
and neuron specific enolase (NSE) activities in post-resuscitation patients concerning
survival and neurologic outcome in comparison to Cerebral Performance Category
(CPC) score. Patients and 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 activity. 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 indicated 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 activities 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 activities and mortality and
unfavorable outcome rates. However, the correlation was more significant with
plasma DNA than with serum NSE. ROC curve analysis revealed that 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
synergistically for prediction of survival and neurologic outcome of post-resuscitation
patients.