59187

ELEVATED AT ADMISSION SERUM NEURON SPECIFIC ENOLASE AND HYPERGLYCEMIA ARE PREDICTORS OF POOR OUTCOME OF POST-RESUSCITATION PATIENTS

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Last updated: 04 Jan 2025

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Abstract

Background: Optimal survival following sudden cardiac arrest requires heart and brain resuscitation. In patients who achieve cardiac resuscitation, brain recovery from anoxic injury is variable. Neurological sequelae range from complete recovery to coma with brain death. Thus, ideally outcome assessment would incorporate functional and neurologic status. Objective: Evaluation of the prognostic yield of estimation of at admission random blood glucose (RBG) and serum neuron specific enolase (NSE) levels, and determination of the value of NSE serum level re-estimation  48 hours after admission in resuscitated post-cardiac arrest patients.                    Patients and Methods: The study included 90 cardiac arrest patients; 75 were out-of-hospital and 15 were  in-hospital cardiac arrest. All patients received mild therapeutic hypothermia irrespective of the initial rhythm admission. Blood samples were obtained for estimation of RBG and serum SNE. At 48-hours after admission, serum NSE was re-estimated, and the percentage of change in relation to at-admission level was calculated. Clinical evaluation was conducted using the Acute Physiology and Chronic Health Evaluation (APACHE II). Mortality rate throughout duration of ICU stay was determined. Neurologic outcomes were evaluated using the Cerebral Performance Category (CPC) score collectively as favorable neurological outcome (CPC score of 1-2) or unfavorable outcome (CPC score of 3-5). Results: Mean time elapsed till return of spontaneous circulation (ROSC) since arrival to emergency department was 14.3±3.6; range: 8-19 minutes. Mean ICU stay was 16.3±7.4; range: 3-30 days. Thirty-one patients died (34.4%), 18 patients (20%) had unfavorable neurological outcome (CPC-3), and 41 patients (45.6%) had favorable outcome. Mean at admission RBG levels were significantly higher in non-survivors compared to survivors, with significantly higher levels in survivors had unfavorable outcome compared to those had favorable outcome. Mean levels of serum NSE estimated at admission and 48-hours, and percentage of change were significantly higher in non-survivors compared to survivors, with significantly higher levels in survivors had unfavorable outcome compared to those had favorable outcome. There was a negative significant correlation between survival rate and favorable neurologic outcome and levels of RBG and NSE, patient's age, time till ROSC and APACHE II score. ROSC curve and regression analyses were defined at admission hyperglycemia as the highly significant specific predictor for mortality and high serum NSE kinetics for prediction of unfavorable neurologic outcome. Conclusion: Hyperglycemia could specifically predict mortality and high serum NSE levels estimated at admission and 48-hours later, with elevated percentage of increase which could specifically predict poor neurologic outcome of resuscitated post-arrest patients.

DOI

10.12816/0029133

Keywords

Post-cardiac arrest, Neuron specific enolase, Serial estimations, mortality, Neurological outcome

Authors

First Name

Abdul R.

Last Name

Aldesouky Alwassef

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Affiliation

Departments of anesthesia &ICU, Al-Azhar Faculty of Medicine

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First Name

Abdel Badee

Last Name

Ameen Ahmed

MiddleName

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Affiliation

Departments of anesthesia &ICU, Al-Azhar Faculty of Medicine

Email

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Orcid

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First Name

Emad

Last Name

Fawzy Shaheen

MiddleName

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Affiliation

Departments of Neurology, Al-Azhar Faculty of Medicine

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Orcid

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First Name

Yasser

Last Name

Hassan Shaaban

MiddleName

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Affiliation

Clinical & Chemical Pathology, Cairo Faculty of Medicine

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-

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Volume

45

Article Issue

2

Related Issue

8926

Issue Date

2016-04-01

Receive Date

2016-04-01

Publish Date

2016-04-01

Page Start

331

Page End

344

Print ISSN

1110-0400

Link

https://amj.journals.ekb.eg/article_59187.html

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https://amj.journals.ekb.eg/service?article_code=59187

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12

Type

Original Article

Type Code

941

Publication Type

Journal

Publication Title

Al-Azhar Medical Journal

Publication Link

https://amj.journals.ekb.eg/

MainTitle

ELEVATED AT ADMISSION SERUM NEURON SPECIFIC ENOLASE AND HYPERGLYCEMIA ARE PREDICTORS OF POOR OUTCOME OF POST-RESUSCITATION PATIENTS

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Article

Created At

22 Jan 2023