A predictive parameter in patients with brain related complications after cardiac surgery?

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Abstract
OBJECTIVE: The prognostic estimation of cerebral complications aftercardiac surgery is a major problem in the early postoperative period.Neuron specific enolase (NSE) is an enzyme involved in glycolysis, which islocalized in neurons and axonal processes. It escapes into the blood andcerebrospinal fluid at the time of neural injury. Therefore we focused thestudy on the question of how far serum levels of neuron specific enolasecan predict the neurological and neuropsychological outcome after cardiacsurgery. METHODS: We determined, with a prospective study design of NSEserum levels in 200 patients undergoing cardiac surgery preoperatively,right after the operation and 48 h later. The NSE was measured with a solidphase enzyme immuno assay which utilized a highly specific monoclonalantibody to NSE. We evaluated the neurological and neuropsychologicalstatus before and 72 h after surgical intervention. As a control group werecruited 50 patients undergoing general surgical treatment. RESULTS: Thepreoperative serum levels of NSE are constantly low in all patients with amean value of 11.1 ng/ml (8.3-13.6) and a mean +/- S.D. of 3.12 in the maingroup and a mean value of 9.6 ng/ml (7.8-10.3) and a mean +/- S.D. of 1.84in the control group. The early postoperative measurements indicated asignificant increase to a mean value of 19.7 ng/ml (8.7-70.9) with a mean+/- S.D. of 2.89 in the main group. In contrast there is no increase of NSEserum levels after general surgery. The 48 h postoperative mean levelsdeclined to 14.2 ng/ml (9.9- 26.2), S.D. of 3.23. In 17 out of the 200patients a neurological complication occurred. Elevated NSE levels werefound in 16 of these 17 patients. The highest concentrations of NSE weremeasured in 7 patients with the most severe neurological complicationsbeing transient ischemic attack and stroke. CONCLUSIONS: The early serumlevels of NSE after cardiopulmonary bypass, in those patients with severeneurological deficits, indicate that NSE is a suitable marker for thedetection and quantification of cerebral injury after open heart surgery.Therefore, in addition NSE seems to be of predictive value for the clinicaloutcome and gives implications for the treatment and prognosis of patientswith brain related complications in cardiac surgery.