PROGNOSTIC MEANING OF SERUM NSE AS THE FACTOR OF BAD OUTCOME IN SECONDARY BRAIN DAMAGE

Abstract

This research is dedicated to the study of brain neuronspecific markers and indicators of brain damage outcome. Purpose of the study: To examine the prognostic role of serum NSE as the predictor of unfavorable outcome in traumatic and vascular brain damages. Methods: Prospective cohort study with 219 patients. Blood serum neuronspecific markers (NSE,S100B),acid-base state, blood gas were derived during the period of observation: upon enrolment, on the 3-rd, 5-th and 7-th days spent in the hospital in the intensive care unit. Results: The most significant risk factor of unfavorable outcome is the marker NSE with the cut point 12,5 ng|ml. The results of the analysis indicate the presence of a statistically significant direct relationship between NSE> 12.5 ng / ml and LDH, compared to other variables, 3.7 times more often; with an increase in blood lactate more than 4,1 mmol/l almost 3,8 times; with GCS 13 points below by 1,7 times; S100≥0,2 by 2,8 times; with an increase of PCO2 <38,5 it was documented more than 3 times often. The measure of certainty the resulting model by the pseudo R2 Nagelkerke criterion-250.6; logLikelihood - 154.04 which corresponds to the excellent predictive ability of the mathematical model. The best predictive value of the model is a cut-off point of 88.89%, AuROC-0.809; Se-51.59%; Sp-95.06%; NPV-55.80%; PPV-94.20%. This model can be used to predict the outcome in patients with acute cerebral pathology. Keywords: strokes, brain traumatic damages, neuronspecific markers, diagnostic and prognostic criterias, stroke outcomes.