Prognostic Value of Neuron-Specific Enolase in Out-of-hospital Cardiac Arrest Patients: Insights into Neurological Outcomes

Introduction Levels of Neuron-specific enolase (NSE), released during neuronal injury, correlate with neurological outcomes after out-of-hospital cardiac arrest (OHCA). The European Resuscitation Council and the European Society of Intensive Care Medicine (ERC-ESICM) guidelines support the use of NSE for neuroprognostication, suggesting a cut-off value of 60 µg/L, although this threshold has not been prospectively validated. We evaluated our cohort data considering current guidelines and investigated the utility of serial NSE measurements for more accurate neuroprognostication. Methods This retrospective cohort study included patients who were successfully resuscitated after OHCA between January 2020 and December 2024. NSE values obtained at 24 h, 48 h and 72 h were collected. Neurological outcomes were assessed at six months using the Cerebral Performance Category (CPC) scale. Results 134 out of 216 patients had a poor six-month neurological outcome (CPC3-5). The predictive performance of NSE72h was stronger compared to NSE48h and NSE24h with an AUC of respectively 0.942, 0.913 and 0.831. Maximum NSE (NSEmax) at 48 h or 72 h demonstrated strong predictive value (AUC 0.933, Fig. 1), with a cut-off of 79.8 µg/L, yielding a specificity of 100%. At the ERC-ESICM cut-off NSE value of 60 µg/L, we found a specificity of 96%. A combined ROC curve (NSEmax and ΔNSE) had an even stronger prediction with an AUC 0.966 (Fig. 1). Conclusion At the cut-off NSE value of 60 µg/L, as recommended by the ERC-ESICM guidelines, we observed high specificity, underscoring its clinical utility. A combined NSEmax ≥ 60 µg/L and a positive ΔNSE value may predict neurological outcomes even more precisely.