JOURNAL READING

The Prognostic Value

of Neuron-specific
Enolase Trauma
patients
Dian Ariska Sahabuddin, S.Ked (105501104821)
Anlis Arsyllah Anwar, S.Ked (105501105821)

Pembimbing : dr. Hartina Harun, Sp. S

ABSTRACT
Dalam beberapa tahun terakhir, selain pemeriksaan neurologis dan pemeriksaan neuroradiologi, upaya yang lain telah

dilakukan untuk menilai tingkat keparahan cedera otak pasca-trauma dan untuk mendapatkan gambaran awal tentang prognosis

pasien menggunakan penanda biokimia dengan tingkat spesifisitas jaringan otak yang tinggi. Salah satu enzim tersebut adalah

enolase spesifik neuron (NSE). Penelitian ini menyelidiki hubungan antara kadar NSE serum, Glasgow Coma Score (GCS), dan

prognosis yang diukur dengan Glasgow Outcome Scores (GOS) pada pasien trauma kepala. Ini adalah studi prospektif yang

dilakukan dengan 80 pasien trauma yang diambil dari bagian kegawatdaruratan, pasien dibagi menjadi empat kelompok.

Kelompok pertama terdiri dari pasien dengan trauma tubuh umum, tetapi tidak ada trauma kepala. Kelompok kedua mengalami

trauma kepala ringan. Kelompok ketiga mengalami trauma kepala sedang, dan kelompok keempat mengalami trauma kepala berat.
SAMPLE
MATERIALS AND METHOD
This was a prospective study with 80 trauma patients presenting to the ED of Karadeniz Technical University

between November 1, 2003 and May 1, 2004. Patients over the age of 18 years presenting within the first 24 h post-trauma

were enrolled in the study. Patients were divided into four groups of 20 patients each. The first group consisted of patients

with general body trauma, but no head trauma. The second group consisted of patients with minor head trauma (GCS > 13).

The third group of patients had moderate head trauma (GCS 9–13) and the fourth group of patients had severe head trauma

(GCS < 9). Enrollment in a given group stopped as soon as 20 patients had been enrolled. Enrollment in the study continued

until there were 20 patients in each group.

MATERIALS AND METHOD
Surviving patients were scheduled for neurosurgery clinic follow-up appointments 1 month later. At that
time their GOS scores were evaluated. Patients who failed to attend the follow-up appointment were contacted by tele-
phone, and their GOS scores were determined. Those who evaluated the GOS were blinded to the initial GCS and NSE
levels.
We investigated the relationship between GSC- defined head trauma groups and initial serum NSE levels.
We also investigated the relationship between initial NSE levels and final GOS results within each head trauma group.
Finally, we examined the relationship between NSE and GCS within each head trauma group. Data were statistically
analyzed using the non-parametric correlation test and the post hoc test.
RESULTS

NSE Results by GCS-Defined NSE Levels within a Head

Head Trauma Group Trauma Group Compared with
GOS Results

NSE Levels within a GCS- NSE Levels as a Predictor of

Defined Head Trauma Group Poor Neurologic Outcome
NSE Results by GCS-Defined Head Trauma Group

The mean NSE level for group 1 (general trauma) was 7.54
ng/mL. For group 2 (mild head trauma), it was 19.62 ng/mL. For group 3
(moderate head trauma), it was 54.52 ng/mL. Finally, for group 4 (severe
head trauma), it was 81.3 ng/mL. There was no significant difference in
NSE levels between groups 1 (general) and 2 (mild) (p > 0.05), but there
was a significant difference in NSE levels between group 1 (general) and
group 3 (moderate). There was also a significant difference in NSE levels
between groups 1 (general) and 4 (severe) (p < 0.05), between groups 2
(mild) and 3 (moderate) (p < 0.05), and between groups 3 (moderate) and
4 (severe) (p < 0.49).
NSE Levels within a GCS-Defined Head Trauma Group

When patients arrival GCS scores and

NSE levels were compared within each head trauma
group, it was determined that GCS tended to fall as
NSE levels rose. But this correlation of admit NSE
and admit GCS was not statistically significant within
groups 1 (general), 3 (moderate), and 4 (severe) (p >
0.05). There was, however, a statistically significant
correlation between NSE and admit GCS within
group 2 (minor head trauma) (p < 0.05).
 NSE Levels within a Head Trauma Group Compared with GOS Results

When NSE levels were compared with their GOS results within each specific initial
GCS-defined head trauma group, it was determined that GOS scores fell as NSE levels rose.
Although there was no statistically significant difference in NSE levels with GOS within group
2 (mild head trauma) (p > 0.05), NSE did vary significantly with GOS within group 3
(moderate head trauma) and within group 4 (severe head trauma) (p < 0.05).
NSE Levels as a Predictor of Poor Neurologic Outcome

A ROC analysis of serum NSE and poor neurologic

outcome was done with combined data from all patient groups. With
unsatisfactory neurologic outcome defined as GOS < 3 and a serum
NSE cutoff value of 20.52 ng/mL, 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.
DISCUSSION
Several experimental and clinical studies have been conducted over
the last 15 years to determine the practicality of NSE as a marker of traumatic
brain injury and patient prognosis. However, the results of these studies reveal no
consistent correlation between NSE and the severity of brain injury.
In the general trauma without head trauma group, NSE levels were
not elevated above normal levels. When compared to the general trauma group,
the mild head trauma group showed a small, but not statistically sig- nificant
increase in NSE. However, a significant elevation of NSE was found in both the
moderate and severe head trauma groups. There was also a significant increase in
serum NSE levels in the severe head trauma group when compared with the
moderate head trauma group.
CONCLUSION
In moderate and severe head trauma patients, if significant hemolysis can be excluded, serum NSE levels
taken within the first 24 h after trauma may provide significant additional prognostic information compared to GCS and
neuroradiologic examinations alone. A larger study with measurements of other trauma severity scores may be useful. It
would be valuable to determine if NSE levels are still helpful for determining neurologic prognosis in patients with
varying degrees of severe blunt trauma. The amount of hemolysis that occurs with major blunt trauma may negate the
usefulness of NSE as a neurologic out- come marker. Also, 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.
THANK
YOU
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