Dynamic changes of serum neuron-specific enolase in patients with single traumatic subarachnoid hemorrhage and its value in predicting prognosis

  Objective  To investigate the expression of serum neuron-specific enolase(NSE) in patients with single traumatic subarachnoid hemorrhage (tSAH) and its value in predicting prognosis.

  Methods  A total of 110 patients with single tSAH were selected. They were divided into good prognosis group (n=70) and poor prognosis group (n=40) according to Glasgow Outcome Scale(GOS)score, Ⅰ to Ⅱ grading group (n=20) and Ⅲ to Ⅳ grading group (n=90) according to Fisher classification, and Ⅰto Ⅲ grading group (n=47) and Ⅳ to Ⅴgrading (n=63) according to Morris-Marshall CT classification.The clinical data of each group was compared. The NSE level of each group was detected by Enzyme-linked immunosorbent assay(ELISA). The prognostic factors were analyzed by multi-factor Logistic regression.The Receiver Operating Characteristic (ROC) curve was used to analyze the predictive value of each factor for the poor prognosis of patients with tSAH.

  Results  The proportions of patients with differed Fisher grading and Morris-Marshall CT grading in the poor prognosis group showed significant differences compared to those in the good prognosis group (P < 0.05). The systolic blood pressure (SBP), diastolic blood pressure (DBP), Glasgow Coma Scale (GCS) score on admission in the poor prognosis group were significantly lower than those in the good prognosis group, while the Acute Physiology and Chronic Health Evalulation Ⅱ (APACHE Ⅱ) score and NSE level in the poor prognosis group on admission were significantly higher than those in the good prognosis group (P < 0.05). The NSE levels in Fisher grading Ⅲ to Ⅳ group and Morris-Marshall CT grade Ⅳ to Ⅴ group on admission, 1st, 3rd and 7th days after treatment were higher than Ⅰ to Ⅱ group and Ⅰ to Ⅲ group (P < 0.05).Fisher Grade (Ⅲ to Ⅳ), Morris-Marshall CT grading (Ⅳ to Ⅴ), SBP (< 100 mmHg), DBP (< 60 mmHg), GCS score (< 8) on admission, APACHE Ⅱ score (scored above 23), and NSE level (>15.5 μg/L) on admission were independent risk factors for poor prognosis in patients with tSAH (P < 0.05). The Area Under The Curve(AUC) of hypotension (SBP < 100 mmHg, DBP < 60 mmHg), Fisher grading (Ⅲ to Ⅳ), Morris-Marshall CT grading (Ⅳ to Ⅴ), admission GCS score (< 8), APACHE Ⅱ score (scored above 23), and admission NSE level (>15.5 μg/L) for patients with tSAH were 0.945, 0.960, 0.976, 0.947, 0.958, 0.977, respectively.

  Conclusion  NSE in patients with single tSAH is significantly elevated, and its level is closely related to the prognosis of patients.