Serum Neuron-specific Enolase and S100 Calcium-binding Protein B in Pediatric Diabetic Ketoacidosis

Abstract

Objective:Neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) are markers of different neurological disorders. The aim was to investigate the relationship between NSE and S100B serum concentrations and the severity of diabetic ketoacidosis (DKA) in diabetic children.Methods:Eighty children with DKA, 40 with type 1 diabetes mellitus (T1DM) without DKA and 40 healthy controls were enrolled. Severity of DKA was assessed according to blood pH and bicarbonate concentration. Serum NSE and S100B were measured in all participants. In the DKA group serum NSE and S100B were measured at three time points, at admission and at 12 hours and 24 hours after starting treatment.Results:Children with DKA showed significantly higher serum levels of NSE at all time points compared to children with T1DM without DKA and controls (p<0.01), while serum S100B concentrations did not differ between the three cohorts. Children with T1DM but without DKA also had significantly higher serum levels of NSE (p<0.01) compared to healthy controls. Patients with low Glasgow Coma Scale score (GCSS) and those with moderate and severe DKA had significantly higher levels of NSE at all time points (p<0.01 for each) compared to patients with normal GCSS and those with mild DKA. No significant differences were found in serum S100B levels according to the severity of DKA and GCS (p>0.05). Younger age, lower GCSS, higher glucose and HbA1c, lower pH and lower serum bicarbonate were the risk factors associated with elevated NSE.Conclusion:Serum NSE is elevated in all patients with type 1 DM and, in patients with DKA, correlates with severity of DKA. However, serum S100B concentration did not differ between T1DM with or without DKA and healthy controls.

Neuron Specific Enolase in Children with Diabetic Ketoacidosis: Does it Correlate with Impaired Consciousness and Disease Severity?

“…The present study found that NSE levels increased before and during diabetic ketoacidosis correction. These findings are consistent with Elshorbagy et al (18) who found higher serum concentrations of NSE in the DKA group at the three-time points: admission (13.9 ± 2.8 ng/mL), 12 hours (27.8 ± 2.3 ng/mL), and 24 hours (36.7 ± 5.6 ng/mL) after starting treatment compared to children with T1DM without DKA (10.2 ± 2.2 ng/mL) and healthy controls (5.17 ± 1.5 ng/mL). Similarly, Hamed et al (5) found a significant increase in serum levels of NSE at three-time points: baseline (14.6 ± 3.2 ug/L), 12 h after the start of therapy (29.7 ± 2.12 ug/L), and 24 h (38.5 ± 6.82 ug/L) after the start of treatment of children with DKA.…”

“…In addition, the healing process in neurological tissues is known to be relatively slow, so persistent NSE elevations might be expected after 24 hours of DKA. NSE levels are high during the critical period when acute complications of DKA have been reported (5,18) . In previous studies, NSE has been found in higher concentrations in patients with diabetes with and without overt neurological complications, and its presence is associated with increased oxidative stress and neuronal apoptosis.…”

Predictive Value and Correlation of Neuron-Specific Enolase for Prognosis in Patients with Coma: A Systematic Review and Meta-Analysis

“…A total of 19 articles and 1,643 patients were included in this part of the meta-analysis [11-29]. Higher heterogeneity existed among these studies ( I 2 = 78%, p < 0.356); thus, a random-effect model was used to calculate the standard mean difference (SMD) and 95% confidence interval (CI) for NSE concentrations (SMD = 0.88, 95% CI: 0.63–1.12, p < 0.05).…”

“…NSE, first described by Moore and McGregor in 1965, is a 78-kDa dimeric isoenzyme of the glycolytic enzyme enolase, localized predominately in the cytoplasm of neurons, which participates in slow axoplasmic transport [10]. Some studies have shown that serum NSE is related to the prognosis of coma in patients with brain damage [11, 12]. However, studies have shown that serum NSE level has nothing to do with the prognosis of coma [13-15].…”

Could the Implantation of Dextranomer/Hyaluronic Acid Cause the Elevation of Neuron-Specific Enolase in Children Treated for Vesicoureteral Reflux?

“…Its measurement is a valuable ancillary method for assessing the outcome after a traumatic brain injury, anoxic encephalopathy after cardiac arrest and stroke [9][10][11]. It has been proven to be elevated in patients with type 1 Diabetes mellitus [12]. As a tumor marker, NSE has been detected in patients with neuroblastoma, carcinoid tumors, medullary thyroid cancer, small cell lung tumor, endocrine tumors of the pancreas and melanoma [7].…”