A PREDICTIVE PARAMETER IN PATIENTS WITH BRAIN RELATED COMPLICATIONS AFTER CARDIAC-SURGERY

Objective: The prognostic estimation of cerebral complications after c ardiac surgery is a major problem in the early postoperative period. N euron specific enolase (NSE) is an enzyme involved in glycolysis, whic h is localized in neurons and axonal processes. It escapes into the bl ood and cerebrospinal fluid at the time of neural injury, Therefore we focused the study on the question of how far serum levels of neuron s pecific enolase can predict the neurological and neuropsychological ou tcome after cardiac surgery. Methods: We determined, with a prospectiv e study design of NSE serum levels in 200 patients undergoing cardiac surgery preoperatively, right after the operation and 48 h later. The NSE was measured with a solid phase enzyme immune assay which utilized a highly specific monoclonal antibody to NSE. We evaluated the neurol ogical and neuropsychological status before and 72 h after surgical in tervention. As a control group pie recruited 50 patients undergoing ge neral surgical treatment. Results: The preoperative serum levels of NS E are constantly low in all patients with a mean value of 11.1 ng/ml ( 8.3-13.6) and a mean +/- S.D. of 3.12 in the main group and a mean val ue of 9.6 ng/ml (7.8-10.3) and a mean +/- S.D. of 1.84 in the control group. The early postoperative measurements indicated a significant in crease to a mean value of 19.7 ng/ml (8.7-70.9) with a mean +/- S.D. o f 2.89 in the main group. In contrast there is no increase of NSE seru m levels after general surgery. The 48 h postoperative mean levels dec lined to 14.2 ng/ml (9.9-26.2), S.D. of 3.23. In 17 out of the 200 pat ients a neurological complication occurred. Elevated NSE levels were f ound in 16 of these 17 patients. The highest concentrations of NSE wer e measured in 7 patients with the most severe neurological complicatio ns being transient ischemic attack and stroke. Conclusions: The early serum levels of NSE after cardiopulmonary bypass, in those patients wi th severe neurological deficits, indicate that NSE is a suitable marke r for the detection and quantification of cerebral injury after open h eart surgery. Therefore, in addition NSE seems to be of predictive val ue for the clinical outcome and gives Implications for the treatment a nd prognosis of patients with brain related complications in cardiac s urgery. (C) 1997 Elsevier Science B.V.