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Meta-analysis of neuron specific enolase in predicting pediatric brain injury outcomes
Babak Nakhjavan-Shahraki1, Mahmoud Yousefifard2, Alireza Oraii3
1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Neuron specific enolase (NSE) levels are significantly higher in children with traumatic brain injury (TBI) who have poor outcomes. While NSE shows moderate predictive ability, more research is needed for reliable TBI outcome prediction in pediatric patients.
Area of Science:
- Pediatric Neurology
- Biomarker Discovery
- Neurotrauma Research
Background:
- Predicting outcomes in pediatric traumatic brain injury (TBI) remains challenging due to the lack of reliable biomarkers.
- Neuron specific enolase (NSE) is a potential biomarker for neuronal damage, but its utility in pediatric TBI requires further investigation.
Purpose of the Study:
- To systematically review and meta-analyze the association between neuron specific enolase (NSE) and traumatic brain injury (TBI) outcomes in children.
- To evaluate the diagnostic performance of NSE in predicting unfavorable outcomes following pediatric TBI.
Main Methods:
- A systematic search of EMBASE, Cochrane library, Medline, and Scopus was conducted by two independent reviewers.
- Meta-analysis included 10 studies, assessing standardized mean difference (SMD) for serum and CSF NSE levels and calculating diagnostic performance metrics for serum NSE.
Main Results:
- Significantly higher serum (SMD=1.3) and CSF (SMD=2.45) NSE levels were observed in children with TBI and unfavorable outcomes.
- Serum NSE demonstrated moderate predictive performance with an area under the curve of 0.75, sensitivity of 0.74, and specificity of 0.69.
- Diagnostic metrics for serum NSE included a positive likelihood ratio of 2.4 and a diagnostic odds ratio of 6.0.
Conclusions:
- NSE shows moderate potential as a biomarker for predicting unfavorable outcomes in pediatric TBI.
- Current data are insufficient, highlighting the need for more extensive research to establish NSE's role in TBI outcome prediction.
Abstract:
A reliable biomarker has not been identified to predict the outcome of traumatic brain injury (TBI) in children. Therefore, the present systematic review and meta-analysis aimed to assess the association between neuron specific enolase (NSE) and traumatic brain injury (TBI) in children. Two independent reviewers searched electronic databases of EMBASE, Cochrane library, Medline and Scopus and then they summarized the results and did a quality control check. At the end, standardized mean difference (SMD) with 95 % confidence interval (CI) and performance of NSE were assessed. 10 studies were included in the present meta-analysis. Average serum (SMD=1.3; 95 % CI: 0.5 to 2.1; p=0.001) and CSF levels (SMD=2.45; 95 % CI: 1.04 to 3.8; p<0.0001) of NSE biomarker were significantly higher in children with TBI with unfavorable outcome compared with other children. Serum NSE had an area under the curve, sensitivity and specificity of 0.75 (95 % CI: 0.72 to 0.79), 0.74 (95 % CI: 0.64 to 0.82) and 0.69 (95 % CI: 0.59 to 0.77), respectively in prediction outcome of TBI. Positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of serum NSE were 2.4 (95 % CI: 1.7 to 3.3), 0.38 (95 % CI: 0.26 to 0.55) and 6.0 (95 % CI: 3.0 to 12.0), respectively. The results show that the performance of NSE is in a moderate level in prediction of unfavorable outcome in children with TBI. However, data in this aspect is not sufficient and more studies are needed.
