Hiponatremili hastalarda serum nöron spesifik enolaz düzeyleri ile beyin hasarı arasındaki ilişki

Year 2022, Volume: 47 Issue: 3, 1147 - 1153, 30.09.2022

Selçuk Matyar Ayça Açıkalın Rana Dişel Ozlem Goruroglu Ozturk Gülçin Dağlıoğlu Onur Akpınar

https://doi.org/10.17826/cumj.1124909

Cited By: 1

Abstract

Amaç: Bu çalışmada hiponatremili hastalarda serum nöron spesifik enolazın santral sinir sistemi hasarını öngörmesi ve klinik gidiş üzerindeki etkilerini araştırmayı amaçladık.
Gereç ve Yöntem: Bu prospektif çalışmada, serum sodyum seviyeleri 135 mEq/L'nin altında olan 75 yetişkin hasta değerlendirildi. Hastalar serum nöron spesifik enolaz düzeylerine göre gruplandırıldı (grup 1 ≤ 17.0 ng/mL ve grup 2 > 17.0 ng/mL). Gruplar demografik ve laboratuvar verilerine göre karşılaştırıldı.
Bulgular: Grup 2 hastalarında hipertansiyon, kalp yetmezliği ve bilinç kaybı insidansı anlamlı olarak daha yüksekti. Yüksek nöron spesifik enolaz seviyeleri, daha düşük serum sodyum seviyeleri ile ilişkiliydi. Ortalama sodyum seviyeleri grup 1 ve 2'de sırasıyla 129.5 ± 4.3 mEq/L ve 126 ± 4.5 mEq/L idi. Grup 2'deki hastalardan (n = 45), bilinç kaybı olan (düşük Glasgow Koma Skalası skorları) (GKS <15) 8 hastada, grup 2'deki diğer hastalara göre (n = 37) serum nöron spesifik enolaz seviyeleri anlamlı olarak daha yüksekti (37.1 ± 6.9 ve 18.6 ± 8.8).
Sonuç: Sonuçlarımız, yüksek nöron spesifik enolaz düzeylerinin daha düşük sodyum düzeyleri ve düşük Glasgow Koma Skalası skorları ile ilişkili olduğunu göstermektedir. Hiponatremili hastalarda nöron spesifik enolaz monitörizasyonunun hangi hastaların bilinç değişikliği yaşayabileceğini öngörebileceğini düşünüyoruz.

Keywords

Acil servis, Hiponatremi, Bilinç kaybı, Nöron spesifik enolaz

Supporting Institution

Çukurova Üniversitesi Yayın Teşvik

Relationship between serum neuron specific enolase levels and brain injury in patients with hyponatremia

Abstract

Purpose: In this study, we aimed to investigate the effects of serum neuron specific enolase on the prediction of central nervous system injury and the clinical course in patients to have hyponatremia.
Materials and Methods: 75 adult patients with serum sodium levels less than 135 mEq/L were evaluated. The patients were grouped according to serum neuron specific enolase levels (group 1 ≤ 17.0 ng/mL and group 2 > 17.0 ng/mL). The groups were compared according to demographic and laboratory data.
Results: The incidence of hypertension, heart failure, and loss of consciousness was significantly higher in group 2 patient. High neuron specific enolase levels were related to lower serum sodium levels. The mean sodium levels were 129.5 ± 4.3 mEq/L and 126 ± 4.5 mEq/L in groups 1 and 2, respectively. Of the patients in group 2 (n = 45), 8 patients with loss of consciousness (low Glasgow Coma Scale scores) (i.e. <15)) had significantly higher serum neuron specific enolase levels than the rest of the patients in group 2 (n = 37) (37.1 ± 6.9 and 18.6 ± 8.8).
Conclusion: High neuron specific enolase levels are associated with lower sodium levels and low Glasgow Coma Scale scores. In patients with hyponatremia, we think that neuron specific enolase monitoring can predict which patients may experience a change in consciousness.

Keywords

Emergency department, Hyponatremia, Loss of consciousness, Neuron specific enolase

References

• Referans 1. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant. 2014; 29(2): i1-i39.
• Referans2. Gankam Kengne F, Decaux G. Hyponatremia and the Brain. Kidney Int Rep. 2018; 3: 24–35.
• Referans3. Nardone R, Brigo F, Trinka E. Acute Symptomatic Seizures Caused by Electrolyte Disturbances. J Clin Neurol. 2016; 12(1): 21-33.
• Referans4. Grant P, Ayuk J, Bouloux PM, Cohen M, Cranston I, Murray RD, et al. The diagnosis and management of inpatient hyponatraemia and SIADH. Eur J Clin Invest. 2015; 45(8): 888-94. https://doi: 10.1111/eci.12465.
• Referans5. Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med. 2006; 119: 1-8.
• Referans6. Dineen R, Thompson CJ, Sherlock M. Hyponatraemia – presentations and management. Clinical Medicine. 2017;17(3): 263-9.
• Referans7. Yuan SM. Biomarkers of cerebral injury in cardiac surgery. Anatol J Cardiol. 2014; 14(7): 638-645.
• Referans8. Tolan NV, Vidal-Folch N, Algeciras-Schimnich A, Singh RJ, Grebe SK. Individualized correction of neuron-specific enolase (NSE) measurement in hemolyzed serum samples. Clin Chim Acta. 2013; 23(424): 216-21.
• Referans9. Mercier E, Boutin A, Shemilt M, Lauzier F, Zarychanski R, Fergusson DA, et al. Predictive value of neuron-specific enolase for prognosis in patients with moderate or severe traumatic brain injury: a systematic review and meta-analysis. CMAJ. 2016; 4(3): 371-82.
• Referans10. Cheng F, Yuan Q, Yang J, Wang W, Liu H. The prognostic value of serum neuron-specific enolase in traumatic brain injury: systematic review and meta-analysis. PLoS One. 2014; 4(9): e106680.
• Referans11. Stammet P, Collignon O, Hassager C, Wise MP, Hovdenes J, Åneman A, et al. Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C. J Am Coll Cardiol. 2015; 65(19): 2104-14.
• Referans12. Kim BJ, Kim YJ, Ahn SH, Kim NY, Kang DW, Kim JS, et al. The second elevation of neuron-specific enolase peak after ischemic stroke is associated with hemorrhagic transformation. J Stroke Cerebrovasc Dis. 2014; 23(9): 2437-43.
• Referans13. Bharosay A, Bharosay VV, Varma M, Saxena K, Sodani A, Saxena R. Correlation of Brain Biomarker Neuron Specific Enolase (NSE) with Degree of Disability and Neurological Worsening in Cerebrovascular Stroke. Indian J Clin Biochem. 2012; 27(2): 186-90.
• Referans14. Liu Q, Fan J, Xu A, Yao L, Li Y, Wang W, et al. Distribution of serum neuron-specific enolase and the establishment of a population reference interval in healthy adults. J Clin Lab Anal. 2019; 19: e22863.
• Referans15. Mjønes P, L Sagatun,. Nordrum IS, Helge L. Neuron-Specific Enolase as an Immunohistochemical Marker Is Better Than Its Reputation. Waldum Journal of Histochemistry & Cytochemistry. 2017; 65(12): 687–703.
• Referans16. Matyar S, Goruroglu Ozturk O, Ziyanoglu Karacor E, Yuzbasioglu Ariyurek S, Sahin G, Kibar F, et al. Biological Variation and Reference Change Value Data for Serum Neuron-Specific Enolase in a Turkish Population. J Clin Lab Anal. 2016; 30(6): 1081-5.
• Referans17. Ayus JC, Achinger SG, Arieff A. Brain cell volume regulation in hyponatremia: role of sex, age, vasopressin, and hypoxia. Am J Physiol Renal Physiol. 295: F619–F624, 2008. First published May 7, 2008.
• Referans18. Hajduková L, Sobek O, Prchalová D, Bílková Z, Koudelková M, Lukášková J, et al. Biomarkers of Brain Damage: S100B and NSE Concentrations in Cerebrospinal Fluid--A Normative Study. Biomed Res Int. 2015:379071.
• Referans19. Rundgren M, Cronberg T, Friberg H, Isaksson A. Serum neuron specific enolase - impact of storage and measuring method. BMC Res Notes. 2014; 15(7): 726.
• Referans20. Lu K, Xu X, Cui S, Wang F, Zhang B, Zhao Y. Serum neuron specific enolase level as a predictor of prognosis in acute ischemic stroke patients after intravenous thrombolysis. J Neurol Sci. 2015; 15(359): 202-6.
• Referans21. Akdemir HU, Yardan T, Kati C, Duran L, Alacam H, Yavuz Y, et al. The role of S100B protein, neuron-specific enolase, and glial fibrillary acidic protein in the evaluation of hypoxic brain injury in acute carbon monoxide poisoning. Hum Exp Toxicol. 2014; 33(11): 1113-20.
• Referans22. Grandi C, Tomasi CD, Fernandes K, Stertz L, Kapczinski F, Quevedo J, et al. Brain-derived neurotrophic factor and neuron-specific enolase, but not S100β, levels are associated to the occurrence of delirium in intensive care unit patients. J Crit Care. 2011; 26(2): 133-7.
• Referans23. Mir IN, Chalak LF. Serum biomarkers to evaluate the integrity of the neurovascular unit. Early Hum Dev. 2014; 90(10): 707-11.
• Referans24. Luescher T, Mueller J, Isenschmid C, Kalt J, Rasiah R, Tondorf T, et al. Neuron-specific enolase (NSE) improves clinical risk scores for prediction of neurological outcome and death in cardiac arrest patients: Results from a prospective trial. Resuscitation. 2019;142:50-60