Neuron-Specific Enolase Levels in Adults Under Venoarterial Extracorporeal Membrane Oxygenation

Reuter, Jean; Peoc’h, Katell; Bouadma, Lila; Ruckly, Stéphane; Chicha-Cattoir, Valérie; Faille, Dorothée; Bourrienne, Marie‐Charlotte; Dupuis, Claire; Magalhaes, Eric; Tanaka, Sébastien; Vinclair, Camille; Montmollin, Étienne de; Mazighi, Mikaël; Para, Marylou; Braham, Wael; Pisani, Angelo; Ajzenberg, Nadine; Timsit, Jean‐François; Sonneville, Romain

doi:10.1097/cce.0000000000000239

Cited by 12 publications

(12 citation statements)

References 28 publications

(31 reference statements)

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“…Notably, although the results of our analysis showed no significant difference between the SAE and NE groups after 24 h, it does not exclude the diagnostic efficacy of NSE for SAE over 24 h. This may be related to the small sample size of studies we included in the over-24 h analysis and the large heterogeneity (up to 99%) among the studies. In addition to this, we found from studies of other diseases that NSE after 72 h was associated with mortality and poor functional prognosis in patients under venoarterial extracorporeal membrane oxygenation (38) as well as in cardiac arrest (39). Therefore, more multicenter large-sample studies are still needed to explore the prognostic role of NSE for prolonged periods of time (>24 h).…”

Section: Discussionmentioning

confidence: 94%

Role of serum neuron-specific enolase levels in the early diagnosis and prognosis of sepsis-associated encephalopathy: a systematic review and meta-analysis

Pei,

Yang,

Zhang

et al. 2024

Front. Neurol.

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BackgroundSepsis-associated encephalopathy (SAE) is one of the most ubiquitous complications of sepsis and is characterized by cognitive impairment, poor prognosis, and a lack of uniform clinical diagnostic criteria. Therefore, this study investigated the early diagnostic and prognostic value of serum neuron-specific enolase (NSE) in SAE.MethodsThis systematic review and meta-analysis systematically searched for clinical trials with serum NSE information in patients with sepsis in the PubMed, Web of Science, Embase, and Cochrane databases from their inception to April 10, 2023. Included studies were assessed for quality and risk of bias using The Quality Assessment of Diagnostic Accuracy-2 tool. The meta-analysis of the included studies was performed using Stata 17.0 and Review Manager version 5.4.FindingsEleven studies were included in this meta-analysis involving 1259 serum samples from 947 patients with sepsis. Our results showed that the serum NSE levels of patients with SAE were higher than those of the non-encephalopathy sepsis group (mean deviation, MD,12.39[95% CI 8.27–16.50, Z = 5.9, p < 0.00001]), and the serum NSE levels of patients with sepsis who died were higher than those of survivors (MD,4.17[95% CI 2.66–5.68, Z = 5.41, p < 0.00001]).ConclusionElevated serum NSE levels in patients with sepsis are associated with the early diagnosis of SAE and mortality; therefore, serum NSE probably is a valid biomarker for the early diagnosis and prognosis of patients with SAE.Systematic review registrationThis study was registered in PROSPERO, CRD42023433111.

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Section: Discussionmentioning

confidence: 94%

Role of serum neuron-specific enolase levels in the early diagnosis and prognosis of sepsis-associated encephalopathy: a systematic review and meta-analysis

Pei,

Yang,

Zhang

et al. 2024

Front. Neurol.

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“…Recent studies suggested an association between NSE levels and outcomes in cardiac arrest patients ( 35 ), stroke patients ( 36 ), VA-ECMO patients ( 16 ), and sepsis-associated encephalopathy ( 37 ). The absence of a significant association between NSE levels and sepsis in our study may be confounded by several factors, including cerebral hypoxia before ECMO cannulation, and hemolysis.…”

Section: Discussionmentioning

confidence: 99%

“…Different non-invasive tools may help clinicians identify brain injury and assist with prognostication during VA-ECMO support ( 14 ). These tools include a clinical evaluation using automated pupillometry ( 15 ), serum neuronal/glial injury biomarkers ( 16 ), spot or continuous EEG ( 17 , 18 ), and neuroimaging in selected cases ( 19 ).…”

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confidence: 99%

Association of Sepsis With Neurologic Outcomes of Adult Patients Treated With Venoarterial Extracorporeal Membrane Oxygnenation

Tridon,

Bachelet,

El Baied

et al. 2024

Critical Care Explorations

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OBJECTIVES: Neurologic outcomes of patients under venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be worsened by secondary insults of systemic origin. We aimed to assess whether sepsis, commonly observed during ECMO support, is associated with brain injury and outcomes. DESIGN: Single-center cohort study of the “exposed-non-exposed” type on consecutive adult patients treated by VA-ECMO. SETTING: Medical ICU of a university hospital, France, 2013–2020. PATIENTS: Patients with sepsis at the time of VA-ECMO cannulation (“sepsis” group) were compared with patients without sepsis (“no sepsis” group). The primary outcome measure was poor functional outcome at 90 days, defined by a score greater than or equal to 4 on the modified Rankin scale (mRS), indicating severe disability or death. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 196 patients were included (“sepsis,” n = 128; “no sepsis,” n = 68), of whom 87 (44.4%) had presented cardiac arrest before VA-ECMO cannulation. A poor functional outcome (mRS ≥ 4) was observed in 99 of 128 patients (77.3%) of the “sepsis” group and 46 of 68 patients (67.6%) of the “no sepsis” group (adjusted logistic regression odds ratio (OR) 1.21, 95% CI, 0.58–2.47; inverse probability of treatment weighting (IPTW) OR 1.24; 95% CI, 0.79–1.95). Subsequent analyses performed according to pre-ECMO cardiac arrest status suggested that sepsis was independently associated with poorer functional outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest (adjusted logistic regression OR 3.44; 95% CI, 1.06–11.40; IPTW OR 3.52; 95% CI, 1.68–7.73), whereas no such association was observed in patients without pre-ECMO cardiac arrest (adjusted logistic regression OR 0.69; 95% CI, 0.27–1.69; IPTW OR 0.76; 95% CI, 0.42–1.35). Compared with the “no sepsis” group, “sepsis” patients presented a significant increase in S100 calcium-binding protein beta concentrations at day 1 (0.94 μg/L vs. 0.52 μg/L, p = 0.03), and more frequent EEG alterations (i.e., severe slowing, discontinuous background, and a lower prevalence of sleep patterns), suggesting brain injury. CONCLUSION: We observed a detrimental role of sepsis on neurologic outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest, but not in other patients.

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“…It is well known that the NSE enzyme is also present in the cell membrane of erythrocytes and platelets and increases in blood with hemolysis. [13,14] We considered that the differences in cross-clamp (CC) and CPB times among the groups could affect the NSE enzyme level. However, when we examined the CC and CPB times of our patients, there was no significant difference among the groups.…”

Section: Discussionmentioning

confidence: 99%

Cerebral effects of different prime solutions used during cardiopulmonary bypass

Kart

Toraman

2023

Turk Gogus Kalp Dama

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Background: This study aims to compare the cerebral, hemodynamic, and metabolic effects of different prime solutions used in patients undergoing coronary artery bypass grafting. Methods: Between May 2013 and May 2014, a total of 30 patients (25 males, 5 females; mean age: 59.5±9 years; range, 42 to 78 years) who were schedule for elective isolated coronary artery bypass grafting were included in this prospective study. The patients were randomized into three groups: Group 1 (n=10) (ringer"s lactate [RL]), Group 2 (n=10) (6% hydroxyethyl starch [HES] 130/0.4), and Group 3 (n=10) (RL + 6% HES 130/0.4). Hemodynamic parameters, arterial blood gas analyses, hemoglobin, hematocrit, cerebral regional oxygen saturation, urine output and fluid balance were recorded preoperatively, before and after anesthesia, 10 min after the transition to extracorporeal circulation, while weaning from extracorporeal circulation, and at the end of surgery. Preoperatively and on postoperative Day 5, neuron-specific enolase enzyme and S-100 ? protein were assessed. On Day 5 and Week 3 postoperatively, the Standardized Mini-Mental Test was administered to the patients. Results: The serum neuron-specific enolase enzyme and S-100 ? protein levels of the patients were within physiological limits, and there were no clinical findings suggestive of cerebral damage, or changes in the Standardized Mini-Mental Test scores in any of the patients. There was a decrease of more than 20% of the baseline value of cerebral regional oxygen saturation in a total of four patients, one in Group 1 and three in Group 3. No significant difference was observed among the groups in terms of the other parameters. Conclusion: The prime solution content has no effect on the development of cerebral damage after cardiopulmonary bypass, and the main factor in preventing the development of cerebral damage was the preservation of cerebral perfusion, which can be achieved by monitoring cerebral perfusion in these patients.

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Neuron-Specific Enolase Levels in Adults Under Venoarterial Extracorporeal Membrane Oxygenation

Abstract: Supplemental Digital Content is available in the text.

Cited by 12 publications

References 28 publications

Role of serum neuron-specific enolase levels in the early diagnosis and prognosis of sepsis-associated encephalopathy: a systematic review and meta-analysis

Role of serum neuron-specific enolase levels in the early diagnosis and prognosis of sepsis-associated encephalopathy: a systematic review and meta-analysis

Association of Sepsis With Neurologic Outcomes of Adult Patients Treated With Venoarterial Extracorporeal Membrane Oxygnenation

Cerebral effects of different prime solutions used during cardiopulmonary bypass

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