AUTHOR=Chen Weiliang , Wang Guanjun , Yao Chunyu , Zhu Zujian , Chen Rui , Su Wen , Jiang Rongcai 

TITLE=The ratio of serum neuron-specific enolase level to admission glasgow coma scale score is associated with diffuse axonal injury in patients with moderate to severe traumatic brain injury

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.887818

DOI=10.3389/fneur.2022.887818

ISSN=1664-2295

ABSTRACT=Background: Moderate to severe traumatic brain injury (TBI) is frequently accompanied by diffuse axonal injury (DAI), considering the low sensitivity of computed tomography (CT) examination for microbleeding and axonal damage, identification of DAI is difficult using conventional diagnostic methods in the acute phase. Neuron-specific enolase (NSE) has been demonstrated to be increased in serum following various types of TBI and is already clinically/commcercially available. We conjecture that serum NSE level to admission GCS score ratio (NGR) may be a useful indicator for early diagnosis of DAI.
Methods: This study included 115 moderate to severe TBI patients who underwent NSE measurements within 6 hours after injury and brain magnetic resonance imaging (MRI) within 30 days. Positive and negative DAI groups were divided according to MRI findings. 
Results: Among the 115 patients, 49 (42.6%) were classified to DAI group and 66 (57.4%) patients to non-DAI group by clinical MRI. The NGR of patients without DAI was found to be significantly lower than those of patients with DAI (p < 0.0001). NGR presented the largest Pearson r value (r=0.755, 95% CI 0.664-0.824, p < 0.0001) and high diagnostic accuracy for DAI (AUC = 0.9493; sensitivity, 90.91%; specificity, 85.71%). TBI patients presenting with higher NGR were more likely to suffer unfavorable neurological outcome (6-month GOSE 1-4).
Conclusions: NGR on admission could serve as an independent predictor of DAI with moderate to severe TBI.