The value of NSE to predict ICU mortality in patients with septic shock: A prospective observational study

Zhang, Litao; Xu, Xin; Han, Hu; Cao, Shumin; L, Li; Lv, Jian; Li-ru, Zhang; Li, Jianguo

doi:10.1097/md.0000000000030941

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…> 12.5µg/L) in sepsis varies between 28 and 53% [ 45 , 46 ]. Previous studies showed a modest increase in NSE concentrations during sepsis, with median serum levels of 6.6 [IQR 4.1–13.8] µg/L [ 45 ], 18.8 [IQR 13.9 –30.5] µg/L [ 34 ], and 30.33 [IQR 19.6–46.5] µg/L [ 47 ].…”

Section: Blood Biomarkersmentioning

confidence: 99%

“…One prospective cohort study found no correlation between NSE levels and mortality at day 28 [ 46 ]. Conversely, two prospective cohorts found an association between NSE levels and ICU or hospital mortality (NSE at day 4 > 25.94µg/L, AUC 0.75 [ 47 ]; NSE > 24.15µg/L, AUC 0.59 [ 48 ]). Another retrospective study demonstrated that abnormal NSE levels on ICU admission were associated with a 23.3% risk of death, and each doubling of NSE level was linked to a 7.3% increased risk of death [ 45 ].…”

Section: Blood Biomarkersmentioning

confidence: 99%

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The spectrum of sepsis-associated encephalopathy: a clinical perspective

Sonneville,

Benghanem,

Jeantin

et al. 2023

Crit Care

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Sepsis-associated encephalopathy is a severe neurologic syndrome characterized by a diffuse dysfunction of the brain caused by sepsis. This review provides a concise overview of diagnostic tools and management strategies for SAE at the acute phase and in the long term. Early recognition and diagnosis of SAE are crucial for effective management. Because neurologic evaluation can be confounded by several factors in the intensive care unit setting, a multimodal approach is warranted for diagnosis and management. Diagnostic tools commonly employed include clinical evaluation, metabolic tests, electroencephalography, and neuroimaging in selected cases. The usefulness of blood biomarkers of brain injury for diagnosis remains limited. Clinical evaluation involves assessing the patient's mental status, motor responses, brainstem reflexes, and presence of abnormal movements. Electroencephalography can rule out non-convulsive seizures and help detect several patterns of various severity such as generalized slowing, epileptiform discharges, and triphasic waves. In patients with acute encephalopathy, the diagnostic value of non-contrast computed tomography is limited. In septic patients with persistent encephalopathy, seizures, and/or focal signs, magnetic resonance imaging detects brain injury in more than 50% of cases, mainly cerebrovascular complications, and white matter changes. Timely identification and treatment of the underlying infection are paramount, along with effective control of systemic factors that may contribute to secondary brain injury. Upon admission to the ICU, maintaining appropriate levels of oxygenation, blood pressure, and metabolic balance is crucial. Throughout the ICU stay, it is important to be mindful of the potential neurotoxic effects associated with specific medications like midazolam and cefepime, and to closely monitor patients for non-convulsive seizures. The potential efficacy of targeted neurocritical care during the acute phase in optimizing patient outcomes deserves to be further investigated. Sepsis-associated encephalopathy may lead to permanent neurologic sequelae. Seizures occurring in the acute phase increase the susceptibility to long-term epilepsy. Extended ICU stays and the presence of sepsis-associated encephalopathy are linked to functional disability and neuropsychological sequelae, underscoring the necessity for long-term surveillance in the comprehensive care of septic patients.

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Section: Blood Biomarkersmentioning

confidence: 99%

Section: Blood Biomarkersmentioning

confidence: 99%

The spectrum of sepsis-associated encephalopathy: a clinical perspective

Sonneville,

Benghanem,

Jeantin

et al. 2023

Crit Care

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“…NSE is already utilized as a biomarker in the differential diagnosis of SCLC. Additionally, NSE holds particular prognostic value for predicting outcomes in patients with severe craniocerebral trauma [ 18 ]. NSE is a well-established marker, and its serum levels are utilized to support the initial diagnosis of SCLC.…”

Section: Introductionmentioning

confidence: 99%

Determination of Tumor Marker Screening for Lung Cancer Using ROC Curves

Dou,

Lu,

et al. 2024

Disease Markers

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Introduction. Lung cancer ranks first among malignant tumors worldwide and is a leading cause of cancer-related mortality in both men and women. Combining tumor marker testing is a strategy to screen individuals at high risk of pulmonary cancer and minimize pulmonary cancer mortality. Therefore, tumor marker screening is crucial. In this study, we analyzed combinations of tumor markers for lung cancer screening using receiver operating characteristic (ROC) curve analysis. Methods. A retrospective descriptive study was conducted on patients diagnosed with lung cancer, as well as healthy and benign lung diseases, using data from the China Huludao Central Hospital database between January 2016 and July 2022. The t-test and ROC curve were utilized to assess the effectiveness of individual tumor marker and the combination of multiple tumor markers. Tumor markers are molecular products metabolized and secreted by tumor tissues, characterized by cells or body fluids. They serve as indicators of tumor stage and grading, monitor treatment response, and predict recurrence. Results. In this study, 267 healthy participants, 385 patients with benign lesions, and 296 patients with lung cancer underwent tumor marker screening. The sensitivity of five tumor markers—CEA, CYFRA21-1, NSE, pro-GRP, and CA125—was found to be <55%. This study revealed that a single tumor marker had limited value in lung cancer screening. However, combining two or more markers yielded varying area under the curves (AUC), with no significant impact on screening accuracy. The combination of CEA + CA125 demonstrated the highest accuracy for lung cancer screening in healthy participants. At a cutoff of 0.447 for CEA + CA125, the combination showed a sensitivity of 0.676 and specificity of 0.846 for lung cancer screening. Conversely, for patients with benign lung lesions, the optimal combination was CEA + NSE, with a cutoff of 0.393, yielding a sensitivity of 0.645 and specificity of 0.766 for lung cancer screening. Conclusion. The five tumor markers—CEA, CA125, CY211, NSE, GRP—show promising results in screening healthy individuals and patients with lung cancer. However, only CEA, NSE, and GRP effectively differentiate patients with benign lung lesions from those with lung cancer. A single tumor marker has limited utility in detecting and screening for lung cancer and should be combined with other tumor markers. CEA + CA125 emerges as a superior tumor marker for distinguishing healthy individuals from those with lung cancer, whereas the CEA + NSE combination is more effective in identifying tumor markers in patients with benign lung lesions and lung cancer.

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