COMPARISON OF NEURON-SPECIFIC ENOLASE, TAU-PROTEIN AND NEUROFILAMENT LIGHT CHAIN VALUES FOR EARLY PROGNOSTICATION IN CARDIAC ARREST SURVIVORS

Introduction: Early prognostication in cardiac arrest survivors remains challenging despite multimodal approach. Currently, the only guidelines recommended biomarker for early prognostication is neuron-specific enolase (NSE).

Objectives: The aim of our study was to compare prognostic values of NSE with novel biomarkers serum tau protein (Tau) and neuro-filament light chain (Nfl) at different timepoints after cardiac arrest. 

Methods: Eligible patients were out-of-hospital cardiac arrest survivors. Blood samples for the measurements of NSE, Tau and Nfl levels were drawn at 24 hrs (D1), 48 hrs (D2), 72 hrs (D3), and 96 hrs (D4) after hospital admission. Thirty-day neurological outcomes according to the Modified Rankin Scale (mRS) were evaluated as clinical endpoints, poor outcome was defined as mRS 4-6. 

Results: We enrolled 43 patients in our study. The area under the ROC curve (AUC) for NSE was 0.776, P˂0.001 at D1, 0.911, P˂0.001 at D2, 0.982, P˂0.001 at D3, and 1.0, P˂0.001 at D4. The AUC for Tau was 0.823, P˂0.001 at D1, 0.893, P˂0.001 at D2, 0.938, P˂0.001 at D3, and 0.980, P˂0.001 at D4. The AUC for Nfl was 0.614, P=0.232 at D1, 0.782, P=0.001 at D2, 0.969, P˂0.001 at D3, and 0.990, P˂0.001 at D4. The comparison of ROC curves revealed trend to lower AUC for Nfl at D1 in comparison to NSE (P=0.151) and Tau (P=0.077) with comparable values at D2, D3 and D4. The highest sensitivity for the prediction of poor prognosis with 100% specificity was detected for Tau values at D1 (33.3%) or D2 (70.0%) and for NSE values at D3 (92.9%) or D4 (100%). 

Conclusions: Our results indicate that the novel biomarkers Tau and Nfl have comparable predictive value for clinical outcomes as NSE at 48 to 96 hrs after cardiac arrest. At the first day after admission the highest predictive value has Tau followed by NSE.