The prognostic value of neuron-specific enolase in head trauma patients.

Department of Emergency Medicine, Ordu General Hospital, Ordu, Turkey.
Journal of Emergency Medicine (Impact Factor: 1.33). 05/2008; 38(3):297-301. DOI: 10.1016/j.jemermed.2007.11.032
Source: PubMed

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: 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.
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