Neuron-specific enolase at admission as a predictor for stroke volume, severity and outcome in ischemic stroke patients: a prognostic biomarker review

Abstract

An ideal blood biomarker for stroke should provide reliable results, enable fast diagnosis, and be readily accessible for practical use. Neuron-specific enolase (NSE), an enzyme released after neuronal damage, has been studied as a marker for brain injury, including cerebral infarction. However, different methodologies and limited sample sizes have restricted the applicability of any potential findings. This work aims to determine whether NSE levels at Emergency Department (ED) admission correlate with stroke severity, infarcted brain volume, functional outcome, and/or death rates. A systematic literature review was performed using PubMed, Embase, and Scopus databases. Each reviewer independently assessed all published studies identified as potentially relevant. All relevant original observational studies (cohort, case–control, and cross-sectional studies) were included. Eleven studies (1398 patients) met the inclusion criteria. Among these, six studies reported a significant correlation between NSE levels and stroke severity, while only one found no association. Four studies indicated a positive relationship between infarcted brain volume assessed by imaging and NSE levels, in contrast to the findings of only one study. Four studies identified an association related to functional outcome and death rates, while three others did not reach statistical significance in their findings. These data highlight that NSE levels at ED admissions proved to be a promising tool for predicting the outcome of ischemic stroke patients in most studies. However, they presented high discrepancies and low robustness. Therefore, further research is necessary to establish and define the role of NSE in clinical practice.

Effect of high-frequency (5Hz) rTMS stimulating left DLPFC combined with galantamine on cognitive impairment after ischemic stroke and serum homocysteine and neuron-specific enolase

“…Studies have shown that serum NSE levels are positively correlated with the size of cerebral infarction and promote local neuroinflammatory response, which is an indicator to judge the severity of brain injury ( 41 ). Recent studies have shown that NSE is closely related to stroke prognosis and is a reliable indicator of stroke functional prognosis ( 42 ). The level of serum NSE is a sensitive biochemical index for judging the degree of brain nerve damage in patients with vascular dementia.…”

Neuron-Specific Enolase—What Are We Measuring?

“…Many studies have shown that measuring NSE concentrations in biological fluids such as serum and cerebrospinal fluid (CSF) is clinically relevant [13][14][15][16]. Serum NSE levels are higher in patients with ischemic stroke than in healthy controls and correlate with infarct size and neurological deficits [17,18].…”