naa a22 4500 51079968X CHVBK 20180411083349.0 cr unu---uuuuu 180411e20131001xx s 000 0 eng 10.1007/s12028-013-9867-5 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9867-5 Serum Neuron-Specific Enolase Levels from the Same Patients Differ Between Laboratories: Assessment of a Prospective Post-cardiac Arrest Cohort [Elektronische Daten] [Michael Mlynash, Marion Buckwalter, Ami Okada, Anna Caulfield, Chitra Venkatasubramanian, Irina Eyngorn, Marcel Verbeek, Christine Wijman] Background: In comatose post-cardiac arrest patients, a serum neuron-specific enolase (NSE) level of >33μg/L within 72h was identified as a reliable marker for poor outcome in a large Dutch study (PROPAC), and this level was subsequently adopted in an American Academy of Neurology practice parameter. Later studies reported that NSE >33μg/L is not a reliable predictor of poor prognosis. To test whether different clinical laboratories contribute to this variability, we compared NSE levels from the laboratory used in the PROPAC study (DLM-Nijmegen) with those of our hospital's laboratory (ARUP) using paired blood samples. Methods: We prospectively enrolled cardiac arrest patients who remained comatose after resuscitation. During the first 3days, paired blood samples for serum NSE were drawn at a median of 10min apart. After standard preparation for each lab, one sample was sent to ARUP laboratories and the other to DLM-Nijmegen. Results: Fifty-four paired serum samples from 33 patients were included. Although the serum NSE measurements correlated well between laboratories (R=0.91), the results from ARUP were approximately 30% lower than those from DLM-Nijmegen. Therapeutic hypothermia did not affect this relationship. Two patients had favorable outcomes after hypothermia despite NSE levels measured by DLM-Nijmegen as >33μg/L. Conclusions: Absolute serum NSE levels of comatose cardiac arrest patients differ between laboratories. Any specific absolute cut-off levels proposed to prognosticate poor outcome should not be used without detailed data on how neurologic outcomes correspond to a particular laboratory's method, and even then only in conjunction with other prognostic variables. Springer Science+Business Media New York, 2013 Cardiac arrest nationallicence Coma nationallicence Neuron-specific enolase nationallicence Prognosis nationallicence Laboratory measurement nationallicence Agreement between clinical measurements nationallicence Mlynash Michael Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut Buckwalter Marion Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut Okada Ami Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut Caulfield Anna Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut Venkatasubramanian Chitra Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut Eyngorn Irina Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut Verbeek Marcel Department of Neurology, Department of Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands aut Wijman Christine Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 161-166 1541-6933 19:2<161 2013 19 12028 https://doi.org/10.1007/s12028-013-9867-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9867-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mlynash Michael Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut NATIONALLICENCE 700 1- Buckwalter Marion Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut NATIONALLICENCE 700 1- Okada Ami Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut NATIONALLICENCE 700 1- Caulfield Anna Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut NATIONALLICENCE 700 1- Venkatasubramanian Chitra Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut NATIONALLICENCE 700 1- Eyngorn Irina Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut NATIONALLICENCE 700 1- Verbeek Marcel Department of Neurology, Department of Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands aut NATIONALLICENCE 700 1- Wijman Christine Stanford Neurocritical Care Program, Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 161-166 1541-6933 19:2<161 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer