UNIVERSITAS AIRLANGGA



Detail Article

Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 17 / No. 1 / Published : 2010-01

Related with : Scholar   Yahoo!   Bing

Original Article :

Correlation between serum neuron-specific enolase and glasgow coma scale in traumatic head injury

Author :

  1. Usi Sukorini*1
  2. Isti Setijorini Wulandari*2
  3. Budi Mulyono*3
  4. Handoyo Pramusinto*4
  1. Bag. PK, FK UGM, RS Dr. Sardjito, Yogyakarta
  2. Post graduate student, Departement of Clinical Pathology, Faculty of Medicine UGM
  3. Bag. PK, FK UGM, RS Dr. Sardjito, Yogyakarta
  4. Departement of Neurosurgery, Sardjito General Hospital, Yogyakarta

Abstract :

The outcome after head injury is mostly determined by Glasgow Coma Scale (GCS) and the degree of brain damage which reveals. CT scan is also important to assess its severity. However  relatively it is not in a less costly manner and sometimes patients mobilisation are needed. Brain damage due to traumatic head injury refers to homeostasis unbalance, and it is the important causes of releasing biochemical analyte from neuron via injured blood brain barrier to circulation. Neuron-specific enolase as a glycolytic enzyme in neuron cytoplasm might increase. Hopefully, measurement of NSE levels can provide information about the extent of the disease. The objective of the study is to test the correlation between the Neuron Specific Enolase (NSE) serum as a one of biochemical marker of brain injury and the GCS. For this purpose, a cross sectional, analytical observasional study was carried out at the Emergency Departement and Departement of Clinical Laboratory, Sardjito General Hospital, Yogyakarta, Indonesia. Fifty-one patients selected by an eligible criteria were included in the study, which consist of severe, moderate and mild head injury. Blood samples were collected and serum NSE was measured by immunoanalyzer using Electro Cheluminescence ImmunoAssay (ECLIA). Chi square test was used to test the difference proportion of the group: NSE ≥ 21.7 ng/mL and NSE < 21.7 ng/mL according to measured variables, and Spearman correlation test was used to correlate serum NSE and GCS, and other variables. In the study fifty-one patients with head injury were included, 74.5% of patients were males and 68.6% is in the age of 15-45 years old. The patients were further divided into two groups on the basis of serum NSE ≥ 21.7 ng/mL and < 21.7 ng/mL; the former group was dominated by severe head injury patients (54.1%). In addition, a proportion of non survivors (66.6%) in group NSE ≥ 21.7 ng/mL was higher compared to those in NSE < 21.7 ng/mL group. Moreover, a large number of mild head injury (95.45%) and survivors (83.33%) had lower serum NSE (< 21.7 ng/mL). In the study, was found a negative correlation between serum NSE and GCS (r=-0.552; p=0.00). Also, serum NSE were inversely correlated with blood kalium and hemoglobin (r=-0.162; p=0.027 dan r=-0.376; p=0.009), in contrast with leucocytes count (r=0.485; p=0.001). The conclusion so far there was a negative correlation between serum NSE and GCS. It is suggested that neuron-specific enolase can be very useful as a biochemical marker in assesssing the severity of head injury. Therefore, it is nessessary to carry out the prognostic study to know to what extent it can predicting the outcomes.       Trauma kepala atau cedera kepala merupakan penyebab kematian terbanyak pada usia kurang dari 45 tahun. Di cedera kepala terutama yang terkait kasus berat sering menimbulkan dampak kecacatan bahkan kematian. Berat atau ringannya cedera kepala ditentukan berdasarkan skala koma Glasgow/Glasgow Coma Scale (GCS) dan diperlukan pemayaran tomografi terkomputer (CT scan) yang nisbi (relatif) mahal dan perlu pelaksanaan (mobilisasi) pasien. Kerusakan otak karena cedera kepala menyebabkan homeostasis terganggu, dan akan berdampak terhadap keseimbangan analisis analit biokimiawi di otak maupun di peredaran (sirkulasi). Penanda kehayatan kimiawi (biokimiawi) kerusakan otak sangat diperlukan untuk membantu penatalaksanaan pasien cedera kepala yang lebih cepat, sederhana (praktis) serta harga relatif lebih terjangkau. Saat ini, penelitian biokimiawi kerusakan otak belum banyak dilakukan. Apakah kerusakan sel neuron yang banyak akibat cedera kepala memberikan dampak terhadap peningkatan rembihan (sekresi) penanda biokimiawi ke peredaran (sirkulasi). Penelitian dilakukan dengan tujuan untuk mengetahui apakah kesatuan saraf enolase khas /Neuron Specific Enolase (NSE) sebagai salah satu penanda biokimiawi kerusakan otak mempunyai pernasaban (korelasi) dengan GCS. Studi dengan rancangan potong lintang amatan (observasional) analitik dilakukan terhadap lima puluh satu pasien cedera kepala yang datang ke Instalasi Rawat Darurat RSUP Dr. Sardjito Yogyakarta yang memenuhi patokan keikutsertaan (kriteria inklusi) dan ketidak-ikutsertaan (eksklusi), diambil darahnya; kemudian diperiksa serum NSE-nya menggunakan cara analisis kekebalan (metode immunoanalyzer) ElectroCheluminescence ImmunoAssay (ECLIA) di Instalasi Laboratorium Klinik RSUP Dr. Sardjito. Uji kenasaban Spearman dilakukan terhadap kadar serum NSE dan GCS, dan peubah (variabel) lain yang diukur (data demografik, awal cedera kepala, tolok ukur kimia kinik dan hematologi). Perbedaan perbandingan (proporsi) antara pesasar (subyek) dengan kadar NSE serum ≥ 21,7 ng/mL dan NSE < 21,7 ng/mL dianalisis dengan uji Chi-square berdasarkan variabel yang diukur. Didapatkan 51 pasien cedera kepala, 68,6% berusia 15-45 tahun dan 31,4, ditonjoli (- dominasi) oleh laki-laki 74,5% dan mengalami cedera kepala berat (47,15%). Perbandingan pasien CKB (54,1%) dan yang meninggal (66,6%) mempunyai kadar NSE ≥ 21,7 ng/mL berbeda bermakna dibandingkan dengan kelompok NSE < 21,7 ng/mL. Sebagian besar (95,45%) pasien CKR dan tidak meninggal (83,33%) mempunyai kadar NSE < 21,7 ng/mL. Pada penelitian ini didapatkan korelasi negatif yang kuat antara kadar serum NSE dan GCS (r=-0,552; p=0,00). Kadar NSE juga bernasab negatif dengan kalium darah dan hemoglobin (r=-0,162; p=0,027 dan r=-0,376; p=0,009) serta mempunyai korelasi positif dengan jumlah leukosit (r=0,485; p=0,001). Kadar serum NSE memiliki korelasi negatif yang kuat dengan nilai GCS. Makin rendah nilai GCS makin tinggi kadar serum NSE. Serum kesatuan saraf khas enolase (Neuron-spesific Enolase serum) dapat dipertimbangkan sebagai penanda tingkat keparahan cedera kepala, oleh karena itu perlu diteliti lebih lanjut terkait dengan uji peramalan (prognosis), sehingga dapat diketahui seberapa jauh NSE dapat memperkirakan keluaran klinis yang terjadi di cedera kepala.

Keyword :

Head injury , Brain injury , Neuron-Specific Enolase , Serum, Glasgow Coma Scale ,


References :

Kukačka, J., Vajtr, D., Huska, D., Průša, R., Houšťava, L., Sama, F., Diopan, V., Kotaska, K., ,(2006) Blood Metallothionein, Neuron Specific Enolase, and Protein S100B in Patients with Traumatic Brain Injury USA : Neuro Endocrinol Lett

Nolan, S,(2005) Traumatic Brain Injury: a Review USA : Crit Care Nurs Q

Pineda, J. A., Wang, K. K. W and Hayes, R,(2003) Biomarkers of Proteolytic Damage Following Traumatic Brain Injury USA : Brain Patholog

Loy, D. N., Sroufe, A. E., Pelt, J. L., Burke, D. A., Qi-lin, C., Talbott, J. F and Whittemore, S. R,(2005) Serum Biomarkers For Experimental Acute Spinal Cord Injury: Rapid Elevation of Neuron-Specific enolase And S-100β USA : Neurosurgery

Pelinka, L. E and Boltzman, L,(2005) Serum Markers of Severe Traumatic Brain Injury: Are They Useful? USA : Scan J Trauma Resusc Emerg Med





Archive Article

Cover Media Content

Volume : 17 / No. : 1 / Pub. : 2010-01
  1. (urine Eosinophyl In Acute Interstitial Nephritis (ain)
  2. Methicillin Resistant On Staphylococcus Aureus At Hospital Ward
  3. The Validity Examination D-dimer Assay Between Immunofiltration Method And Immunoturbidimetric Method
  4. Plasma Secretory Phospholipase-a2 Activity Inthrombocytopenic Dengue Haemorrhagic Fever
  5. Dengue Virus Profile In Surabaya From 2008-2009
  6. Correlation Between Serum Neuron-specific Enolase And Glasgow Coma Scale In Traumatic Head Injury
  7. Cut Off Value Dengue Quantitative Ns1 Antigen As Predictor Severity Of Dengue Viral Infection In Children
  8. The Role Of γ-interferron Gene (ifng) Polymorphism In Phenotype Histology Lupus Nephritis
  9. Quantification Of Gram Staining On Various Specimens
  10. Flaming Cells In Multiple Myeloma

Information CPML