title: Admission plasma levels of the neuronal injury marker neuron-specific enolase are associated with mortality and delirium in sepsis.
abstract: Neuron-specific enolase (NSE) concentrations are prognostic following traumatic and anoxic brain injury and may provide a method to quantify neuronal injury in other populations. We determined the association of admission plasma NSE concentrations with mortality and delirium in critically ill septic patients.
  
  
  
  We performed a retrospective analysis of 124 patients from a larger sepsis cohort. Plasma NSE was measured in the earliest blood draw at intensive care unit admission. Primary outcomes were 30-day mortality and intensive care unit delirium determined by chart review.
  
  
  
  Sixty-one patients (49.2%) died within 30 days, and delirium developed in 34 (31.5%) of the 108 patients who survived at least 24 hours and were not persistently comatose. Each doubling of the NSE concentration was associated with a 7.3% (95% confidence interval [CI] 2.5-12.0, P= .003) increased risk of 30-day mortality and a 5.2% (95% CI 3.2-7.2, P< .001) increased risk of delirium. An NSE concentration >12.5 μg/L was independently associated with a 23.3% (95% CI 6.7-39.9, P= .006) increased risk of 30-day mortality and a 29.3% (95% CI 8.8-49.8, P= .005) increased risk of delirium.
  
  
  
  Higher plasma NSE concentrations were associated with mortality and delirium in critically ill septic patients, suggesting that NSE may have utility as a marker of neuronal injury in sepsis.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Anderson
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: John P
authors.initials: JP
authors.lastname: Reilly
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Michael G S
authors.initials: MGS
authors.lastname: Shashaty
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Palakshappa
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Alex
authors.initials: A
authors.lastname: Wysoczanski
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Dunn
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Altaf
authors.initials: A
authors.lastname: Kazi
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Anna
authors.initials: A
authors.lastname: Tommasini
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: William D
authors.initials: WD
authors.lastname: Schweickert
authors.affiliation: Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Kolson
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
authors.forename: Nuala J
authors.initials: NJ
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality; D003693:Delirium / Q000097:blood / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010414:Pennsylvania; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018805:Sepsis
chemical_list: D015415:Biomarkers; D010751:Phosphopyruvate Hydratase
keywords: Brain injury; Critical care; Delirium; Neuron-specific enolase; Sepsis