The ratio of serum neuron-specific enolase level to admission glasgow coma scale score is associated with diffuse axonal injury in patients with moderate to severe traumatic brain injury

Abstract

BackgroundModerate to severe traumatic brain injury (TBI) is frequently accompanied by diffuse axonal injury (DAI). Considering the low sensitivity of computed tomography (CT) examination for microbleeds and axonal damage, identification of DAI is difficult using conventional diagnostic methods in the acute phase. Neuron-specific enolase (NSE) has been demonstrated to be increased in serum following various types of TBI and is already clinically/commercially available. We conjecture that serum NSE level to admission GCS score ratio (NGR) may be a useful indicator for the early diagnosis of DAI.MethodsThis study included 115 patients with moderate-to-severe TBI who underwent NSE measurements within 6 h after injury and brain magnetic resonance imaging (MRI) within 30 days. The positive and negative DAI groups were divided according to MRI findings.ResultsAmong the 115 patients, 49 (42.6%) were classified into the DAI group and 66 (57.4%) patients into the non-DAI group by clinical MRI. The NGR of patients without DAI was found to be significantly lower than those of patients with DAI (p < 0.0001). NGR presented the largest Pearson r value (r = 0.755, 95% CI 0.664–0.824, p < 0.0001) and high diagnostic accuracy for DAI [area under the curve (AUC) = 0.9493; sensitivity, 90.91%; and specificity, 85.71%]. Patients with TBI presenting with higher NGR were more likely to suffer an unfavorable neurological outcome [6-month extended Glasgow Outcome Scale (GOSE) 1–4].ConclusionsThe NGR on admission could serve as an independent predictor of DAI with moderate-to-severe TBI.

Cognitive impairment in diffuse axonal injury patients with favorable outcome

“…Analysis of 228 patients with TBI showed that education status was correlated with MoCA scores: Those patients with higher level of education had significant association with higher MoCA scores ( p = 0.012) ( Panwar et al, 2019 ). Marshall CT score, pupillary light reflex, duration of coma and admission GCS were predictors of clinical outcome in DAI ( Palmieri et al, 2021 ; Xie et al, 2021 ; Chen et al, 2022 ). In the present study we also confirmed that return of consciousness, Marshall CT score, age and DAI grade have a negative correlation with cognitive function in DAI patients with 6-month GOSE 5–8.…”

“…DAI is caused by acceleration-deceleration or rotational forces on brain tissues, resulting in axonal shear injuries and delayed axonal disconnection, categorized as a special type of traumatic brain injury (TBI) ( Mu et al, 2021 ; Zhou et al, 2021 ; Chen et al, 2022 ; Kim et al, 2022 ). A total of 20–38% of TBI patients with DAI were followed up with unfavorable outcome (Extended Glasgow Outcome Scale, GOSE 1–4) ( Humble et al, 2018 ; Lohani et al, 2020 ), but over 85% suffered from persistent cognitive impairment ( Macruz et al, 2022 ; RaukolaLindblom et al, 2022 ).…”

“…The Hopkins Language Learning Test (HVLT), Trail Making Test (TMT), and Rey-Osterrieth Complex Figure test were used to assess neuropsychological results in 25 DAI patients at 6 and 12 months post-traumatic, revealed that patients' episodic verbal memory, attention, and executive function were improved at 6 and 12 months after the trauma (Macruz et al, 2022). All of the above test methods could only evaluate certain domains of Neurocognition, and the Montreal Cognitive Assessment (MoCA) (Nasreddine et al, 2005) was considered to be a more appropriate scale to comprehensively assess cognitive function after traumatic brain injury, subarachnoid hemorrhage, stroke and Alzheimer's disease (Cornea et al, 2022;Holguin et al, 2022;Wang et al, 2022). MoCA and resting-state perfusion magnetic resonance imaging were performed in 40 patients with acute mild TBI and 40 healthy controls within 14 days following injury to elucidate the relationship between cerebral blood flow connectivity differences and cognitive outcomes in the acute phase after mild TBI (Duan et al, 2022).…”

Dynamic Changes in Neuron-specific Enolase Level to Glasgow Coma Scale Score Ratio Predict Long-term Neurological Function of Diffuse Axonal Injury Patients

“…We need to explore convenient collected, objective, and dynamically predictive indicators. Our previous studies have found that NGR at admission could be used as an independent predictor of DAI [7], so we further hypothesized that the dynamic changes in NGR can more accurately predict the long-term neurological function of DAI patients and provide support for disease assessment and treatment strategy.…”

“…If DAI can be diagnosed early after TBI and the long-term neurological function of these patients can be accurately predicted, appropriate treatment measures and early targeted rehabilitation programs can be given to DAI patients with a high probability of unfavorable outcome, which will be of great help in improving their prognosis [6][7][8]. Therefore, many scholars were committed to exploring prognosis assessment schemes for DAI.…”