Publication: Enolasa neuroespecífica como marcador bioquímico de pronóstico neurológico en supervivientes de una parada cardiorrespiratoria
Authors
López Hernández, Nayara
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Escuela Internacional de Doctorado
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Gea García, José Higinio de
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Objetivo: Evaluar el valor pronóstico de la Enolasa neuroespecífica (NSE) en los supervivientes de una parada cardiorrespiratoria (PCR) y determinar los valores umbral a las 24, 48 y 72 horas que permitan identificar a aquellos con mal pronóstico neurológico.
Metodología: Estudio observacional, longitudinal, descriptivo y retrospectivo de los pacientes supervivientes de una PCR ingresados en la Unidad de Cuidados Intensivos (UCI) de un hospital de tercer nivel entre 2016 y 2024.
Resultados: Se analizaron los datos de 135 pacientes con una media de edad de 58,48 años. El ritmo inicial de PCR fue con mayor frecuencia el ritmo no desfibrilable (50,75 %) y la mediana de tiempo total de PCR fue de 22 minutos. Los valores medios de NSE fueron significativamente inferiores en el grupo con buen resultado neurológico a los 6 meses frente al grupo con mal resultado en todas las franjas temporales: a las 24 horas 35 vs 68 ng/mL (p < 0,001); a las 48 horas 26 vs
158,5 ng/mL (p < 0,001); a las 72 horas 15 vs 185 ng/mL (p < 0,001); a las 96 horas 20 vs 117 ng/mL (p < 0,001); y a las 110 horas 16 vs 92 ng/mL (p = 0,02). En relación con los valores umbral, a las 48 horas un nivel mayor o igual a 57 ng/mL predijo un mal resultado neurológico con una especificidad del 100 % y una sensibilidad del 92,86 %. A las 72 horas, un valor mayor o igual a 71 ng/mL también se asoció a mal pronóstico neurológico, con una especificidad del 100 % y una sensibilidad del 80,77 %.
Conclusiones: La NSE es un buen predictor del resultado neurológico a los seis meses. Los valores umbral de 57 ng/mL a las 48 horas y 71 ng/mL a las 72 horas podrían ser de utilidad dentro de la valoración multimodal de los pacientes con encefalopatía hipóxico-isquémica.
Objective: To assess the prognostic value of neuron-specific enolase (NSE) in survivors of cardiac arrest and to identify threshold levels at 24, 48, and 72 hours that may help predict poor neurological outcomes. Methods: An observational, longitudinal, descriptive, and retrospective study included cardiac arrest survivors admitted to the Intensive Care Unit (ICU) of a tertiary hospital between 2016 and 2024. Results:Data from 135 patients were analyzed, with a mean age of 58.48 years. The initial cardiac arrest rhythm was most frequently non-shockable (50.75 %), and the median total duration of cardiac arrest was 22 minutes. Mean NSE levels weresignificantly lower in the group with good neurological outcome at 6 months compared with the group with poor outcome across all time points: at 24 hours, 35 vs 68 ng/mL (p < 0.001); at 48 hours, 26 vs 158.5 ng/mL (p < 0.001); at 72 hours, 15vs 185 ng/mL (p < 0.001); at 96 hours, 20 vs 117 ng/mL (p < 0.001); and at 110 hours, 16 vs 92 ng/mL (p = 0.02). Regarding threshold values, at 48 hours an NSE level greater than or equal to 57 ng/mL predicted poor neurological outcome with 100 % specificity and 92.86% sensitivity, whereas at 72 hours a threshold greater than or equal to 71 ng/mL predicted poor neurological outcome with 100 % specificity and 80.77% sensitivity. Conclusions: NSE is a reliable predictor of neurological outcome at six months. Threshold values of 57 ng/mL at 48 hours and 71 ng/mL at 72 hours may be valuable components of the multimodal assessment of patients with hypoxic-ischemic encephalopathy.
Objective: To assess the prognostic value of neuron-specific enolase (NSE) in survivors of cardiac arrest and to identify threshold levels at 24, 48, and 72 hours that may help predict poor neurological outcomes. Methods: An observational, longitudinal, descriptive, and retrospective study included cardiac arrest survivors admitted to the Intensive Care Unit (ICU) of a tertiary hospital between 2016 and 2024. Results:Data from 135 patients were analyzed, with a mean age of 58.48 years. The initial cardiac arrest rhythm was most frequently non-shockable (50.75 %), and the median total duration of cardiac arrest was 22 minutes. Mean NSE levels weresignificantly lower in the group with good neurological outcome at 6 months compared with the group with poor outcome across all time points: at 24 hours, 35 vs 68 ng/mL (p < 0.001); at 48 hours, 26 vs 158.5 ng/mL (p < 0.001); at 72 hours, 15vs 185 ng/mL (p < 0.001); at 96 hours, 20 vs 117 ng/mL (p < 0.001); and at 110 hours, 16 vs 92 ng/mL (p = 0.02). Regarding threshold values, at 48 hours an NSE level greater than or equal to 57 ng/mL predicted poor neurological outcome with 100 % specificity and 92.86% sensitivity, whereas at 72 hours a threshold greater than or equal to 71 ng/mL predicted poor neurological outcome with 100 % specificity and 80.77% sensitivity. Conclusions: NSE is a reliable predictor of neurological outcome at six months. Threshold values of 57 ng/mL at 48 hours and 71 ng/mL at 72 hours may be valuable components of the multimodal assessment of patients with hypoxic-ischemic encephalopathy.
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