title: The Relationship Between Serum Neuron-Specific Enolase Levels and Severity of Bleeding and Functional Outcomes in Patients With Nontraumatic Subarachnoid Hemorrhage.
abstract: BACKGROUND
  The value of neuron-specific enolase (NSE) in predicting clinical outcomes has been investigated in a variety of neurological disorders.
  
  
  OBJECTIVE
  To investigate the associations of serum NSE with severity of bleeding and functional outcomes in patients with subarachnoid hemorrhage (SAH).
  
  
  METHODS
  We retrospectively reviewed the records of patients with SAH from June 2008 to June 2012. The severity of SAH bleeding at admission was measured radiographically with the Fisher scale and clinically with the Glasgow Coma Scale, Hunt and Hess grade, and World Federation of Neurologic Surgeons scale. Outcomes were assessed with the modified Rankin Scale at discharge.
  
  
  RESULTS
  We identified 309 patients with nontraumatic SAH, and 71 had NSE testing. Median age was 54 years (range, 23-87 years), and 44% were male. In multivariable analysis, increased NSE was associated with a poorer Hunt and Hess grade (P = .003), World Federation of Neurologic Surgeons scale score (P < .001), and Glasgow Coma Scale score (P = .003) and worse outcomes (modified Rankin Scale at discharge; P = .001). There was no significant association between NSE level and Fisher grade (P = .81) in multivariable analysis.
  
  
  CONCLUSIONS
  We found a significant association between higher NSE levels and poorer clinical presentations and worse outcomes. Although it is still early for any relevant clinical conclusions, our results suggest that NSE holds promise as a tool for screening patients at increased risk of poor outcomes after SAH.
authors.affiliation: *Department of Neurosurgery, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida; ‡Division of Biomedical Statistics and Informatics, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida; §Department of Neurology, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida; Departments of ¶Critical Care and ‖Neurology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Rabih G
authors.initials: RG
authors.lastname: Tawk
authors.forename: Sanjeet S
authors.initials: SS
authors.lastname: Grewal
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Rawal
authors.forename: David A
authors.initials: DA
authors.lastname: Miller
authors.forename: Drucilla
authors.initials: D
authors.lastname: Edmonston
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ferguson
authors.forename: Ramon
authors.initials: R
authors.lastname: Navarro
authors.forename: Lauren
authors.initials: L
authors.lastname: Ng
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Brown
authors.forename: James F
authors.initials: JF
authors.lastname: Meschia
authors.forename: William D
authors.initials: WD
authors.lastname: Freeman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000097:blood*; D006801:Humans; D000068880:Isophane Insulin, Human; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000201:enzymology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000068880:Isophane Insulin, Human; D010751:Phosphopyruvate Hydratase