Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest
Background To determine neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA) and treatment with mild therapeutic hypothermia (MTH). Methods Seventy-three consecutive OHCA patients treated with MTH were retrospectively analyzed. Serum neuron-specific enolase (NSE) was measured 24...
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| Veröffentlicht in: | Neurocritical care 2014-06, Vol.20 (3), p.358-366 |
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| creator | Huntgeburth, Michael Adler, Christoph Rosenkranz, Stephan Zobel, Carsten Haupt, Walter F. Dohmen, Christian Reuter, Hannes |
| description | Background
To determine neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA) and treatment with mild therapeutic hypothermia (MTH).
Methods
Seventy-three consecutive OHCA patients treated with MTH were retrospectively analyzed. Serum neuron-specific enolase (NSE) was measured 24, 48, and 72 h after admission. In patients with no motor response 48 h after termination of analgosedation (
n
= 40), clinical neurological examination and evoked potentials (EPs) were determined. Neurological outcome was assessed after 2 months based on the cerebral performance categories (CPC), and categorized as good (CPC 1–3) or poor (CPC 4 and 5).
Results
Forty-three patients had a CPC score of 1–3 and 30 patients had a CPC 4–5. The best predictive value for poor neurologic outcome was an increase of NSE by ≥4.3 ng/mL between day 1 and day 2 (sensitivity 80 %, specificity 100 %, positive predictive value (PPV) 100 %, negative predictive value 86 %). Absolute NSE values were less reliable in the prediction of poor outcome with the highest sensitivity (88 %) and specificity (95 %) if values reached ≥36.3 ng/mL on day 3. Somatosensory EPs (SSEPs) showed a specificity of 100 % and PPV of 100 %; however, sensitivity for evoked potentials was low (29 %). Intriguingly, two initially comatose patients with excessive NSE values (24 h NSE: 101 and 256 ng/mL, and 48 h NSE: 93 and 110 ng/mL, respectively) had physiological SSEPs and regained a CPC score of 1.
Conclusion
In patients treated with MTH after OHCA changes in NSE are more suitable than its absolute serum levels for the prediction of poor neurologic outcome. Since unequivocal prediction of poor neurologic outcome is of utmost importance in these patients the decision to limit therapy must be based on several prediction tools with the highest PPV and specificity including SSEPs. |
| doi_str_mv | 10.1007/s12028-013-9848-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1544012637</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1532946174</sourcerecordid><originalsourceid>FETCH-LOGICAL-c405t-3c90af7c63ef309bf73f3a872dce560ec3127ca61c8f6893951055dd7a9837e33</originalsourceid><addsrcrecordid>eNqNkl1rFDEYhQdRbK3-AG8k4I030XzM5ONyWWq3sNpC1-shm3nTTZmZrEmm0n_nT2uGqQqC4E0SeJ9zDklOVb2l5CMlRH5KlBGmMKEca1UrrJ5Vp7RpBCZa0OfzuaZYaM5Pqlcp3RHCpJbNy-qEccVFzerT6uf6YMZbSMiP6CtMMYz45gjWO2_R-Rh6kwCZCOhLKMvN5LPZ94B2RYQuc0KrfQr9lMsI4jSgLdxDn5ALEeUDoOsInbfZhxEFt9j34bY4X03ZhgHm0M3DMRQ2Dt7gXQSToUPXJnsYi_0Pnw8zjIPDm5COJb5HaxM7byxaxQgpv65eONMnePO0n1XfPp_v1hu8vbq4XK-22NakyZhbTYyTVnBwnOi9k9xxoyTrLDSCgOWUSWsEtcoJpbluKGmarpNGKy6B87Pqw-J7jOH7VILbwScLfW9GCFNqy1vXhDLB5X-gnOlaUFkX9P1f6F2Y4lgu0jJNtaSiVnM2XSgbQ0oRXHuMfjDxoaWknZvQLk1oSxPauQmtKpp3T87TfoDut-LX1xeALUAqo1KB-Cf6366PcOG_4w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2919716483</pqid></control><display><type>article</type><title>Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest</title><source>MEDLINE</source><source>Springer Online Journals - JUSTICE</source><source>ProQuest Central</source><creator>Huntgeburth, Michael ; Adler, Christoph ; Rosenkranz, Stephan ; Zobel, Carsten ; Haupt, Walter F. ; Dohmen, Christian ; Reuter, Hannes</creator><creatorcontrib>Huntgeburth, Michael ; Adler, Christoph ; Rosenkranz, Stephan ; Zobel, Carsten ; Haupt, Walter F. ; Dohmen, Christian ; Reuter, Hannes</creatorcontrib><description>Background
To determine neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA) and treatment with mild therapeutic hypothermia (MTH).
Methods
Seventy-three consecutive OHCA patients treated with MTH were retrospectively analyzed. Serum neuron-specific enolase (NSE) was measured 24, 48, and 72 h after admission. In patients with no motor response 48 h after termination of analgosedation (
n
= 40), clinical neurological examination and evoked potentials (EPs) were determined. Neurological outcome was assessed after 2 months based on the cerebral performance categories (CPC), and categorized as good (CPC 1–3) or poor (CPC 4 and 5).
Results
Forty-three patients had a CPC score of 1–3 and 30 patients had a CPC 4–5. The best predictive value for poor neurologic outcome was an increase of NSE by ≥4.3 ng/mL between day 1 and day 2 (sensitivity 80 %, specificity 100 %, positive predictive value (PPV) 100 %, negative predictive value 86 %). Absolute NSE values were less reliable in the prediction of poor outcome with the highest sensitivity (88 %) and specificity (95 %) if values reached ≥36.3 ng/mL on day 3. Somatosensory EPs (SSEPs) showed a specificity of 100 % and PPV of 100 %; however, sensitivity for evoked potentials was low (29 %). Intriguingly, two initially comatose patients with excessive NSE values (24 h NSE: 101 and 256 ng/mL, and 48 h NSE: 93 and 110 ng/mL, respectively) had physiological SSEPs and regained a CPC score of 1.
Conclusion
In patients treated with MTH after OHCA changes in NSE are more suitable than its absolute serum levels for the prediction of poor neurologic outcome. Since unequivocal prediction of poor neurologic outcome is of utmost importance in these patients the decision to limit therapy must be based on several prediction tools with the highest PPV and specificity including SSEPs.</description><identifier>ISSN: 1541-6933</identifier><identifier>EISSN: 1556-0961</identifier><identifier>DOI: 10.1007/s12028-013-9848-8</identifier><identifier>PMID: 23836424</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anesthesia ; Biomarkers - blood ; Cardiac arrest ; Cardiac arrhythmia ; Cardiopulmonary resuscitation ; Catheters ; Coma ; Coma - diagnosis ; Coma - therapy ; Contraindications ; Cooling ; CPR ; Critical Care ; Critical Care Medicine ; Disability ; Emergency services ; Enzymes ; Evoked Potentials ; Female ; Hospitals ; Humans ; Hypothermia ; Hypothermia, Induced ; Intensive ; Intensive care ; Internal Medicine ; Male ; Medical prognosis ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurologic Examination ; Neurology ; Original Article ; Out-of-Hospital Cardiac Arrest - diagnosis ; Out-of-Hospital Cardiac Arrest - therapy ; Patients ; Phosphopyruvate Hydratase - blood ; Physiology ; Predictive Value of Tests ; Recovery of Function ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Standard of care ; Treatment Outcome ; Ventilators</subject><ispartof>Neurocritical care, 2014-06, Vol.20 (3), p.358-366</ispartof><rights>Springer Science+Business Media New York 2013</rights><rights>Springer Science+Business Media New York 2013.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-3c90af7c63ef309bf73f3a872dce560ec3127ca61c8f6893951055dd7a9837e33</citedby><cites>FETCH-LOGICAL-c405t-3c90af7c63ef309bf73f3a872dce560ec3127ca61c8f6893951055dd7a9837e33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12028-013-9848-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2919716483?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,21367,27901,27902,33721,33722,41464,42533,43781,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23836424$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huntgeburth, Michael</creatorcontrib><creatorcontrib>Adler, Christoph</creatorcontrib><creatorcontrib>Rosenkranz, Stephan</creatorcontrib><creatorcontrib>Zobel, Carsten</creatorcontrib><creatorcontrib>Haupt, Walter F.</creatorcontrib><creatorcontrib>Dohmen, Christian</creatorcontrib><creatorcontrib>Reuter, Hannes</creatorcontrib><title>Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest</title><title>Neurocritical care</title><addtitle>Neurocrit Care</addtitle><addtitle>Neurocrit Care</addtitle><description>Background
To determine neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA) and treatment with mild therapeutic hypothermia (MTH).
Methods
Seventy-three consecutive OHCA patients treated with MTH were retrospectively analyzed. Serum neuron-specific enolase (NSE) was measured 24, 48, and 72 h after admission. In patients with no motor response 48 h after termination of analgosedation (
n
= 40), clinical neurological examination and evoked potentials (EPs) were determined. Neurological outcome was assessed after 2 months based on the cerebral performance categories (CPC), and categorized as good (CPC 1–3) or poor (CPC 4 and 5).
Results
Forty-three patients had a CPC score of 1–3 and 30 patients had a CPC 4–5. The best predictive value for poor neurologic outcome was an increase of NSE by ≥4.3 ng/mL between day 1 and day 2 (sensitivity 80 %, specificity 100 %, positive predictive value (PPV) 100 %, negative predictive value 86 %). Absolute NSE values were less reliable in the prediction of poor outcome with the highest sensitivity (88 %) and specificity (95 %) if values reached ≥36.3 ng/mL on day 3. Somatosensory EPs (SSEPs) showed a specificity of 100 % and PPV of 100 %; however, sensitivity for evoked potentials was low (29 %). Intriguingly, two initially comatose patients with excessive NSE values (24 h NSE: 101 and 256 ng/mL, and 48 h NSE: 93 and 110 ng/mL, respectively) had physiological SSEPs and regained a CPC score of 1.
Conclusion
In patients treated with MTH after OHCA changes in NSE are more suitable than its absolute serum levels for the prediction of poor neurologic outcome. Since unequivocal prediction of poor neurologic outcome is of utmost importance in these patients the decision to limit therapy must be based on several prediction tools with the highest PPV and specificity including SSEPs.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia</subject><subject>Biomarkers - blood</subject><subject>Cardiac arrest</subject><subject>Cardiac arrhythmia</subject><subject>Cardiopulmonary resuscitation</subject><subject>Catheters</subject><subject>Coma</subject><subject>Coma - diagnosis</subject><subject>Coma - therapy</subject><subject>Contraindications</subject><subject>Cooling</subject><subject>CPR</subject><subject>Critical Care</subject><subject>Critical Care Medicine</subject><subject>Disability</subject><subject>Emergency services</subject><subject>Enzymes</subject><subject>Evoked Potentials</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypothermia</subject><subject>Hypothermia, Induced</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurologic Examination</subject><subject>Neurology</subject><subject>Original Article</subject><subject>Out-of-Hospital Cardiac Arrest - diagnosis</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Patients</subject><subject>Phosphopyruvate Hydratase - blood</subject><subject>Physiology</subject><subject>Predictive Value of Tests</subject><subject>Recovery of Function</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Standard of care</subject><subject>Treatment Outcome</subject><subject>Ventilators</subject><issn>1541-6933</issn><issn>1556-0961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkl1rFDEYhQdRbK3-AG8k4I030XzM5ONyWWq3sNpC1-shm3nTTZmZrEmm0n_nT2uGqQqC4E0SeJ9zDklOVb2l5CMlRH5KlBGmMKEca1UrrJ5Vp7RpBCZa0OfzuaZYaM5Pqlcp3RHCpJbNy-qEccVFzerT6uf6YMZbSMiP6CtMMYz45gjWO2_R-Rh6kwCZCOhLKMvN5LPZ94B2RYQuc0KrfQr9lMsI4jSgLdxDn5ALEeUDoOsInbfZhxEFt9j34bY4X03ZhgHm0M3DMRQ2Dt7gXQSToUPXJnsYi_0Pnw8zjIPDm5COJb5HaxM7byxaxQgpv65eONMnePO0n1XfPp_v1hu8vbq4XK-22NakyZhbTYyTVnBwnOi9k9xxoyTrLDSCgOWUSWsEtcoJpbluKGmarpNGKy6B87Pqw-J7jOH7VILbwScLfW9GCFNqy1vXhDLB5X-gnOlaUFkX9P1f6F2Y4lgu0jJNtaSiVnM2XSgbQ0oRXHuMfjDxoaWknZvQLk1oSxPauQmtKpp3T87TfoDut-LX1xeALUAqo1KB-Cf6366PcOG_4w</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Huntgeburth, Michael</creator><creator>Adler, Christoph</creator><creator>Rosenkranz, Stephan</creator><creator>Zobel, Carsten</creator><creator>Haupt, Walter F.</creator><creator>Dohmen, Christian</creator><creator>Reuter, Hannes</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>20140601</creationdate><title>Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest</title><author>Huntgeburth, Michael ; Adler, Christoph ; Rosenkranz, Stephan ; Zobel, Carsten ; Haupt, Walter F. ; Dohmen, Christian ; Reuter, Hannes</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-3c90af7c63ef309bf73f3a872dce560ec3127ca61c8f6893951055dd7a9837e33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia</topic><topic>Biomarkers - blood</topic><topic>Cardiac arrest</topic><topic>Cardiac arrhythmia</topic><topic>Cardiopulmonary resuscitation</topic><topic>Catheters</topic><topic>Coma</topic><topic>Coma - diagnosis</topic><topic>Coma - therapy</topic><topic>Contraindications</topic><topic>Cooling</topic><topic>CPR</topic><topic>Critical Care</topic><topic>Critical Care Medicine</topic><topic>Disability</topic><topic>Emergency services</topic><topic>Enzymes</topic><topic>Evoked Potentials</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypothermia</topic><topic>Hypothermia, Induced</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurologic Examination</topic><topic>Neurology</topic><topic>Original Article</topic><topic>Out-of-Hospital Cardiac Arrest - diagnosis</topic><topic>Out-of-Hospital Cardiac Arrest - therapy</topic><topic>Patients</topic><topic>Phosphopyruvate Hydratase - blood</topic><topic>Physiology</topic><topic>Predictive Value of Tests</topic><topic>Recovery of Function</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Standard of care</topic><topic>Treatment Outcome</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huntgeburth, Michael</creatorcontrib><creatorcontrib>Adler, Christoph</creatorcontrib><creatorcontrib>Rosenkranz, Stephan</creatorcontrib><creatorcontrib>Zobel, Carsten</creatorcontrib><creatorcontrib>Haupt, Walter F.</creatorcontrib><creatorcontrib>Dohmen, Christian</creatorcontrib><creatorcontrib>Reuter, Hannes</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Neurocritical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huntgeburth, Michael</au><au>Adler, Christoph</au><au>Rosenkranz, Stephan</au><au>Zobel, Carsten</au><au>Haupt, Walter F.</au><au>Dohmen, Christian</au><au>Reuter, Hannes</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest</atitle><jtitle>Neurocritical care</jtitle><stitle>Neurocrit Care</stitle><addtitle>Neurocrit Care</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>20</volume><issue>3</issue><spage>358</spage><epage>366</epage><pages>358-366</pages><issn>1541-6933</issn><eissn>1556-0961</eissn><abstract>Background
To determine neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA) and treatment with mild therapeutic hypothermia (MTH).
Methods
Seventy-three consecutive OHCA patients treated with MTH were retrospectively analyzed. Serum neuron-specific enolase (NSE) was measured 24, 48, and 72 h after admission. In patients with no motor response 48 h after termination of analgosedation (
n
= 40), clinical neurological examination and evoked potentials (EPs) were determined. Neurological outcome was assessed after 2 months based on the cerebral performance categories (CPC), and categorized as good (CPC 1–3) or poor (CPC 4 and 5).
Results
Forty-three patients had a CPC score of 1–3 and 30 patients had a CPC 4–5. The best predictive value for poor neurologic outcome was an increase of NSE by ≥4.3 ng/mL between day 1 and day 2 (sensitivity 80 %, specificity 100 %, positive predictive value (PPV) 100 %, negative predictive value 86 %). Absolute NSE values were less reliable in the prediction of poor outcome with the highest sensitivity (88 %) and specificity (95 %) if values reached ≥36.3 ng/mL on day 3. Somatosensory EPs (SSEPs) showed a specificity of 100 % and PPV of 100 %; however, sensitivity for evoked potentials was low (29 %). Intriguingly, two initially comatose patients with excessive NSE values (24 h NSE: 101 and 256 ng/mL, and 48 h NSE: 93 and 110 ng/mL, respectively) had physiological SSEPs and regained a CPC score of 1.
Conclusion
In patients treated with MTH after OHCA changes in NSE are more suitable than its absolute serum levels for the prediction of poor neurologic outcome. Since unequivocal prediction of poor neurologic outcome is of utmost importance in these patients the decision to limit therapy must be based on several prediction tools with the highest PPV and specificity including SSEPs.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>23836424</pmid><doi>10.1007/s12028-013-9848-8</doi><tpages>9</tpages></addata></record> |
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| ispartof | Neurocritical care, 2014-06, Vol.20 (3), p.358-366 |
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| subjects | Adult Aged Aged, 80 and over Anesthesia Biomarkers - blood Cardiac arrest Cardiac arrhythmia Cardiopulmonary resuscitation Catheters Coma Coma - diagnosis Coma - therapy Contraindications Cooling CPR Critical Care Critical Care Medicine Disability Emergency services Enzymes Evoked Potentials Female Hospitals Humans Hypothermia Hypothermia, Induced Intensive Intensive care Internal Medicine Male Medical prognosis Medicine Medicine & Public Health Middle Aged Neurologic Examination Neurology Original Article Out-of-Hospital Cardiac Arrest - diagnosis Out-of-Hospital Cardiac Arrest - therapy Patients Phosphopyruvate Hydratase - blood Physiology Predictive Value of Tests Recovery of Function Retrospective Studies ROC Curve Sensitivity and Specificity Standard of care Treatment Outcome Ventilators |
| title | Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest |
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