Can Neuron Specific Enolase Be a Diagnostic Biomarker for Neuronal Injury in COVID-19?

Ganti, Latha; Serrano, Enrique; Toklu, Hale Z.

doi:10.7759/cureus.11033

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…Finally, in patients with tuberculosis, NSE levels were elevated in 91.66% of cases, suggesting the highest sensitivity that could be useful for the diagnosis of smear-negative tuberculosis and acute military tuberculosis secondary to tuberculous meningitis [ 8 , 17 ]. Recently, a four-fold increase in NSE was reported in the CSF of a patient with SARS-CoV-2 infection [ 18 ]. Based on this single observation, the authors suggested that NSE could be a diagnostic/prognostic biomarker for neuroinflammation in patients infected with SARS-CoV-2, and particularly in patients with neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

Neuron-specific enolase serum levels in COVID-19 are related to the severity of lung injury

et al. 2021

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The multifunctional role of neuron-specific enolase (NSE) in lung diseases is well established. As the lungs are greatly affected in COVID-19, we evaluated serum NSE levels in COVID-19 patients with and without dyspnea. In this study, we evaluated both SARS-CoV-2-infected and uninfected patients aged >18 years who were referred to hospitals in Catanzaro, Italy from March 30 to July 30, 2020. Epidemiological, clinical, and radiological characteristics, treatment, and outcome data were recorded and reviewed by a trained team of physicians. In total, 323 patients (178 men, 55.1% and 145 women, 44.9%) were enrolled; of these, 128 were COVID-19 patients (39.6%) and 195 were control patients (60.4%). Westergren’s method was used to determine erythroid sedimentation rate. A chemiluminescence assay was used for measurement of interleukin-6, procalcitonin, C-reactive protein, and NSE. We detected significantly higher NSE values (P<0.05) in COVID-19 patients than in controls. Interestingly, within the COVID-19 group, we also observed a further significant increase in dyspnea (Dyspnea Scale and Exercise score: 8.2 ± 0.8; scores ranging from 0 to 10, with higher numbers indicating very severe shortness of breath). These data provide the background for further investigations into the potential role of NSE as a clinical marker of COVID-19 progression.

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Section: Discussionmentioning

confidence: 99%

Neuron-specific enolase serum levels in COVID-19 are related to the severity of lung injury

et al. 2021

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“…The viral genome was found in the CSF in a small percentage of these patients. It is possible that systemic inflammation is a determining factor in these cases; however, this cannot be definitively stated since systemic inflammation was not evaluated in the present study with regard to encephalitis 5 , 8 , 10 - 12 , 14 - 25 , 27 - 29 , 32 - 76 . Other factors, such as hypoxia, metabolic alterations and drugs with effect on the CNS, may also have contributed but were not separately analyzed in the studies included in this review.…”

Section: Discussionmentioning

confidence: 83%

“…A mild increase in CSF protein concentration (< 100 mg/dl) was found in 269 patients, moderate increase (100-200 mg/dl) in nine cases and high increase (> 200 mg/dl) in three cases. The highest concentration was found in a patient with a CNS inflammatory syndrome with CSF protein concentration of 803 mg/dl 7 , 8 , 11 - 17 , 19 , 21 , 25 - 27 , 31 , 32 , 34 - 37 , 49 - 76 . SARS-CoV-2 CSF RT-PCR: A search for SARS-CoV-2 genetic material in CSF samples by means of RT-PCR was reported in 243 cases.…”

Section: Resultsmentioning

confidence: 91%

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Cerebrospinal fluid analysis in patients with COVID-19-associated central nervous system manifestations: a systematic review

Domingues¹,

Brunale²,

Senne³

2022

Arq. Neuro-Psiquiatr.

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Background: Central nervous system (CNS) symptoms may occur in patients with acute COVID-19. The role of CSF examination in these patients remains to be established. Objective: A systematic review of CSF findings relating to COVID-19 was carried out. Methods: CSF parameters, including cytological and biochemical analyses, SARS-CoV-2 RT-PCR and other CSF markers, were recorded and analyzed among patients with acute COVID-19 and one of the following CNS syndromes: stroke, encephalopathy, encephalitis, inflammatory syndromes, seizure, headache and meningitis. Results: Increased white blood cells and/or increased protein concentration were found in 52.7% of the patients with encephalitis, 29.4% of the patients with encephalopathy and 46.7% of the patients with inflammatory syndromes (P < 0.05). CSF RT-PCR for SARS-CoV-2 was positive in 17.35% of the patients with encephalitis and less than 3.5% of the patients with encephalopathy or inflammatory syndromes (P < 0.05). Intrathecal production of immunoglobulins was found in only 8% of the cases. More than 85% of the patients had increased CSF cytokines and chemokines. Increased CSF neurofilament light chain (NfL) and CSF Tau were found in 71% and 36% of the cases, respectively. Conclusion: Non-specific inflammatory CSF abnormalities were frequently found in patients with COVID-19 CNS syndromes. The increase in neurodegeneration biomarkers suggests that neuronal damage occurs, with long-term consequences that are still unknown.

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“… 17 Regarding COVID‐19, CSF studies revealed increased NSE levels in two case reports infected with COVID‐19; one is associated with sepsis, 15 another is accompanied by increased white blood cell count and elevated protein somehow indicating neuroinflammation. 18 However, there is a single study in the literature, performed by Savarraj et al 13 showing elevated NSE levels in the acute phase of COVID‐19. Neurofilament light chain (NFL), a measure of neuro‐axonal injury, is located in the neuronal axons and it has been implicated in the maintenance of axonal integrity.…”

Section: Introductionmentioning

confidence: 99%

Neurological symptoms and neuronal damage markers in acute COVID‐19: Is there a correlation? A pilot study

Çelikbilek

Koçak

et al. 2022

Journal of Medical Virology

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A wide spectrum of neurological symptoms (NS) has been described in patients with COVID‐19. We examined the plasma levels of neuron‐specific enolase (NSE) and neurofilament light chain (NFL) together, as neuronal damage markers, and their relationships with clinical severity in patients with NS at acute COVID‐19. A total of 20 healthy controls and 59 patients with confirmed COVID‐19 were enrolled in this pilot prospective study. Serum NSE and NFL levels were measured by using the enzyme‐linked immunoassay method from serum samples. Serum NSE levels were found to be significantly higher in the severe group than in the nonsevere group (p = 0.034). However, serum NFL levels were similar between the control and disease groups (p > 0.05). For the mild group, serum NFL levels were significantly higher in patients with the sampling time ≥5 days than in those with the sampling time <5 days (p = 0.019). However, no significant results for NSE and NFL were obtained in patients with either single or multiple NS across the groups (p > 0.05). Increased serum NSE levels were associated with disease severity regardless of accompanied NS in patients with acute COVID‐19 infection. However, serum NFL levels may have a role at the subacute phase of COVID‐19.

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Can Neuron Specific Enolase Be a Diagnostic Biomarker for Neuronal Injury in COVID-19?

Cited by 6 publications

References 9 publications

Neuron-specific enolase serum levels in COVID-19 are related to the severity of lung injury

Neuron-specific enolase serum levels in COVID-19 are related to the severity of lung injury

Cerebrospinal fluid analysis in patients with COVID-19-associated central nervous system manifestations: a systematic review

Neurological symptoms and neuronal damage markers in acute COVID‐19: Is there a correlation? A pilot study

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