Abstract
ObjectivesNeuron-specific enolase (NSE) is frequently used to predict neurological outcomes in patients with hypoxic brain injury. Hanging can cause hypoxic brain damage, and survivors can suffer from neurological deficits that may impair daily activities. Here, we investigated the utility of the initial serum NSE level as a predictor of neurological outcomes in near-hanging patients with decreased consciousness.MethodsThis retrospective multicenter study was conducted in patients who visited the emergency department due to near-hanging injury from October 2013 to February 2019 at three university hospitals in Korea. They were divided into two groups according to the presence of out-of-hospital cardiac arrest. The neurological outcome was determined using the Cerebral Performance Category (CPC) measured at the time of discharge. Multivariate analysis was performed to determine whether initial serum NSE is an independent predictor of neurological outcome.ResultsOf the 70 patients included in the study, 44 showed a poor neurological outcome (CPC score = 3–5). Among the 52 patients with cardiac arrest, only 10 (19.2%) were discharged with good neurological outcome (CPC score = 1–2). In the whole cohort, a high serum NSE level was a significant predictor of poor neurological outcome (odds ratio [OR], 1.343; 95% confidence interval [CI], 1.003–1.800, p = 0.048). Among the patients with cardiac arrest, a high serum NSE level was a significant predictor of poor neurological outcome (OR, 1.138; 95% CI, 1.009–1.284, p = 0.036).ConclusionsIn near-hanging patients, a high initial serum NSE level is an independent predictor of poor neurological outcome.
Highlights
In the USA, the annual suicide rate due to suffocation has increased steadily from 2.7 per 100,000 in 1999–2007 to 3.7 per 100,000 in 2008–2015 [1]
A high serum Neuron-specific enolase (NSE) level was a significant predictor of poor neurological outcome
Among the patients with cardiac arrest, a high serum NSE level was a significant predictor of poor neurological outcome (OR, 1.138; 95% confidence intervals (CIs), 1.009–1.284, p = 0.036)
Summary
In the USA, the annual suicide rate due to suffocation has increased steadily from 2.7 per 100,000 in 1999–2007 to 3.7 per 100,000 in 2008–2015 [1]. It is important to predict the neurological outcome of near-hanging patients. The serum NSE level is normally low in healthy people but increases significantly in cases of neuronal tissue damage, such as traumatic brain injury and stroke, and so is used as a biomarker for brain damage [7]. The serum NSE level increases in cases of hypoxic brain damage; the serum concentration is proportional to the extent of brain damage [9]. As nearhanging injury causes anoxic brain injury [10], serum NSE level is expected to predict the neurological outcome of near-hanging patients. The prognostic value of NSE in nearhanging patients is not clear
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