The prognostic value of neuron-specific enolase in head trauma patients.
ABSTRACT In recent years, in addition to neurological examination and neuroradiologic examinations, attempts have been made to assess the severity of post-traumatic brain injury and to obtain an early idea of patient prognosis using biochemical markers with a high degree of brain tissue specificity. One such enzyme is neuron-specific enolase (NSE). This study investigates the correlation between serum NSE levels, Glasgow Coma Score, and prognosis measured by Glasgow Outcome Scores in head trauma patients. This was a prospective study conducted with 80 trauma patients presenting to the Emergency Department. Patients were divided into four groups. The first group consisted of patients with general body trauma, but no head trauma. The second group had minor head trauma. The third group had moderate head trauma, and the fourth group had severe head trauma. The relationship between subjects' admission NSE levels and admission and discharge Glasgow Coma Scores (GCS) and Glasgow Outcome Scores (GOS) 1 month later was examined. A receiver operating characteristic (ROC) analysis was performed using a serum NSE cutoff level of 20.52 ng/mL and a GOS of 3 or less as the definition of poor neurologic outcome. There was a significant difference in the NSE levels between group 1 (general trauma) and group 3 (moderate head trauma). There was also a statistically significant difference in NSE levels between group 1 (general trauma) and group 4 (severe head trauma) (p < 0.05). There was a statistically significant inverse relationship between NSE levels and GOS as determined within groups 3 (moderate) and 4 (severe head trauma) (p < 0.05). When NSE levels were compared with admission GCS, it was found that GCS fell as NSE levels rose. There was no significant correlation between NSE and GCS within groups 3 (moderate) or 4 (severe). There was a statistically significant correlation within group 2 (mild) (p < 0.05). By ROC analysis, serum NSE was 87% sensitive and 82.1% specific in predicting poor neurologic outcome in the study patients. The area under the curve was 0.931. This study shows that initial serum NSE levels in moderate and severe head trauma patients correlate inversely with GOS 1 month later, but only within the moderate and severe head trauma groups. However, serum NSE was 87% sensitive and 82.1% specific in predicting poor neurologic outcome in all of the study patients. This derived cutoff value now needs to be prospectively validated.
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ABSTRACT: Although several publications concerning the use of the biomarkers S100B and NSE in vertebral spine fractures in animal experimental studies have proven their usefulness as early indicators of injury severity, there are no clinical reports on their effectiveness as indicators in patients with spinal injuries. As these biomarkers have been examined-with promising results-in patients with traumatic brain injury (TBI), there is a potential for their implementation in patients with vertebral spine fractures. To investigate the early serum measurement of S100B and NSE in patients with vertebral spine fractures as compared to those in patients with acute fractures of the proximal femur. Prospective longitudinal cohort study. A cohort of 34 patients admitted over an 18-month period to a single medical center for suspected vertebral spine trauma. 29 patients were included in the control group. S100B and NSE serum levels were assessed in different types of vertebral spine fractures. We included patients over 16 years of age with vertebral spine fractures whose injuries were sustained within 24 hours prior to admission to the emergency room, and who had undergone a brief neurological examination. Spinal cord injuries were classified as being either paraesthesias, incomplete paraplegias or complete paraplegias. Blood serum was obtained from all patients within 24 hours after time of injury. Serum levels of S100B and NSE were statistically analyzed using Wilcoxon tests. S100B serum levels were significantly higher in patients with vertebral spine fractures (p=0.01). In these patients, the mean S100B serum level was 0.75 μg/L (SD 1.44) [95% CI 0.24; 1.25]. The mean S100B serum level in control group patients was 0.14 μg/L (SD 0.11) [0.10; 0.19]. The 10 patients with neurological deficits had significantly higher S100B serum levels when compared to the patients with vertebral fractures but without neurological deficits (p=0.02). The mean S100B serum level in these patients was 1.18 μg/L (SD 1.96). In the 26 patients with vertebral spine fractures but without neurological injury, the mean S100B serum level was 0.42 μg/L (SD 0.91) [95% CI 0.08; 0.76]. The analysis revealed no significant difference in NSE levels. Not only did we observed a significant correlation between S100B serum levels and vertebral spine fractures, a significant correlation was also seen between S100B serum levels and spinal cord injuries with neurological deficit. These results may be meaningful in clinical practice, and to future studies as well.The spine journal: official journal of the North American Spine Society 04/2014; · 2.90 Impact Factor
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ABSTRACT: To observe the effects of Danshen aqueous extract (DSAE) on the cerebral tissue and nerve stem cells in cerebral ischemia reperfusion (CIR) rats. The model rats were prepared by occlusion of the middle cerebral artery for 2 h and then by reperfusion. They were randomly divided into five groups: a control group, an CIR group and three DSAE-treated groups. As compared with the sham control group, there was significant increase (P < 0.05, P < 0.01) in the serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-8 (IL-8) levels, interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) levels, and IL-10 mRNA, TNF-α mRNA expression levels, function score, Infarct size, TUNEL + cell counts, cerebral transforming growth factor beta 1 (TGF-β1) positive expression and cerebral neuron specific enolase (NSE) levels, and decrease in fas-associated protein with death domain (FADD) and death-associated protein (Daxx) positive expression levels in the CIR group. Compared with CIR group, DSAE treatment dose-dependently significantly decreased serum hs-CRP, IL-8, IL-10, TNF-α levels, and IL-10 mRNA, TNF-α mRNA expression levels, function score, Infarct size, TUNEL + cell counts, cerebral TGF-β1 positive expression and cerebral NSE levels, and increase FADD and Daxx positive expression levels in the CIR + DSAE groups. Taken together, these results suggest that DSAE has a neuroprotective role in the CIR rats, which may be related to improvement of immunity function, proteins and genes expression.Molecular Biology Reports 02/2013; · 2.51 Impact Factor
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ABSTRACT: Background The development and the use of biochemical markers for assessment of brain injury severity have been of considerable interest. The most promising marker of brain damage is considered to be neuron-specific enolase (NSE); predominantly located in neurons and neuroectodermal cells.PurposeTo investigate the serum levels of NSE in patients with head injury admitted to ICU and to correlate them with their outcome and other clinical parameters.MethodsA total of 20 patients admitted to the critical care unit, MISR University for science and technology Hospital with head injury; including traumatic brain injury and those with stroke either ischemic or hemorrhagic stroke were included in the study. NSE was measured in venous blood samples collected on ICU admission and at 48 h of admission. Clinical data and final outcome of survival/mortality rates were recorded for all patients.ResultsPatients age ranged from 20 to 80 years with a mean (50.8 ± 16.5), 18 of them were males (90%) and two were females (10%). There were no statistical significant difference between NSE level in traumatic (8.8 ± 8.1) or non traumatic patients (10.9 ± 7.9) (p value = 0.3). There was a significant correlation between NSE level and the progression of CT findings. Moreover, NSE showed statistically significant higher level estimation in those patients with moderate and severe brain injury (17.2 ± 13.5) than in mild brain injury (7.1 ± 4.8) (p = 0.04) together with significant negative correlation between NSE and GCS on admission (p = 0.01 & r = −0.564) as well as the changes in GCS assessment after 48 h. Upon estimating the prognostic role of NSE and its ability in detecting outcome; NSE was significantly higher in non survivors (20 ± 14) than in survivors (8.9 ± 6.7) (p < 0.05). Also, it was significantly higher in those with bad outcome (severe disability) than those who recover or with mild disability (p < 0.05). By statistical analysis; an optimal cutoff value of NSE level of 18 μg/L was determined to predict ICU mortality and 7.9 μg/L to predict bad outcome with a high sensitivity and specificity.Conclusion Neuron specific enclose can be used as a potentially useful marker for brain damage and can be considered to be a relevant parameter for assessing the prognosis of brain injury.The Egyptian Journal of Critical Care Medicine. 01/2013; 1(1):25–32.