Serum Neuron–specific Enolase as a Prognostic Marker for Irreversible Brain Damage in Comatose Cardiac Arrest Survivors

Abstract

Objective: To assess the use of serum neuron-specific enolase (S-NSE) level as a noninvasive predictor of CNS injury irreversibility in comatose cardiac arrest survivors.Methods: An observational, prospective clinical study was performed in a community hospital ED and intensive care unit. All cardiac arrest survivors ( n = 52) with impaired neurologic status admitted between February 1994 and May 1995 were followed until return of consciousness (1) or death due to CNS failure (0). Serum samples for S-NSE determination (ng/mL) using the radioimmunoassay technique were obtained 24 hours after cardiac arrest. Data were analyzed using stepwise logistic regression with dichotomized predictors to validate the correlation between S-NSE (X) and outcome (Y), where X = 0 if 5 median and 1 if > median S-NSE level. Adjustment was made for the following variables: glucose level on admission, total epinephrine dose used before return of spontaneous circulation, and best Glasgow Coma Scale score on admission. These data were all available in 34 cases. In 16 cases, CSF enzymes at 48 hours postarrest were obtained and compared with S-NSE. Results:The logistic equation determining the influence of S-NSE (X) on outcome (Y) was: Y = 0.606 -1.785X (odds ratio = 6; p = 0.020). There was no confounding effect of the other variables related to survival. The mean S-NSE value for all the patients was 34 (7.9-188). All the patients recovering consciousness (n = 15) had an S-NSE mean ? SEM value of 17.5 t 2.4, with a maximum of 47. Conclusion:These data support the conclusion that measurement of S-NSE at 24 hours post-cardiac arrest may supplement clinical assessment of hypoxic-ischemic encephalopathy after cardiac arrest.

Astroglial Protein S-100 Is an Early and Sensitive Marker of Hypoxic Brain Damage and Outcome After Cardiac Arrest in Humans

“…11 Therefore, recent attention focuses on biochemical markers of hypoxic brain damage. [13][14][15][16]22 To be an ideal marker for brain injury, the marker should be proved to be released from neurons or glial cells in experimental settings, for example cell cultures. Such proofs exist for NSE 32 but not for S-100.…”

“…This is in line with the fact that NSE, as in the present study, has shown promising results at later stages after cardiac arrest. [13][14][15][16] In contrast, release from blood cells in particular circumstances is not the case with S-100. The presence of S-100 in serum indicates cellular brain injury and damage to the blood-brain barrier.…”

“…Biochemical markers of hypoxic brain damage such as neuron-specific enolase (NSE), however, have also shown promising results only at later stages (ie, Ͼ24 hours after cardiac arrest). [13][14][15][16] Recently, S-100 has been found to be a promising marker for central nervous system injury. [17][18][19][20][21][22][23][24] Protein S-100 is part of a large family of calcium-binding proteins, and evidence exists that S-100 regulates calciumdependent cellular signaling in neuronal differentiation, outgrowth, and apoptosis through different concentrations.…”

Part 8: Advanced Life Support

“…Consensus on Science Serum neuronal-specific enolase (NSE) elevations are associated with poor outcome for comatose patients after cardiac arrest (LOE P1 905,906 ; LOE P2 852,894,897,[907][908][909][910][911][912][913][914][915][916][917][918][919][920] ; LOE P3 921,922 Serum S100 elevations are associated with poor outcome for comatose patients after cardiac arrest (LOE P1 905,906 ; LOE P2 894,897,907,913,915,917,918,[923][924][925][926][927][928] ; LOE P3 921 ).…”

Exploring the Role of Biomarkers for the Diagnosis and Management of Traumatic Brain Injury Patients

“…The most extensively studied among these are glial protein S-100 beta( ) [45][46][47][48][49][50][51][52][53][54][55] , neuron-specific enolase (NSE) [56][57][58][59][60][61][62][63] , and myelin basic protein (MBP) 41,59,[64][65][66] Although some of these published studies suggest that these biomarkers correlate with degree of injury; conflicting results exist. [67][68][69][70][71][72][73][74][75] S100 is the major low affinity calcium binding protein in astrocytes 76 and it is considered a marker of astrocyte injury or death. It can also be found in non-neural cells such as adipocytes, chondrocytes, and melanoma cells.…”