Admission plasma levels of the neuronal injury marker neuron specific enolase are associated with mortality and delirium in sepsis

Abstract Purpose Neuron specific enolase (NSE) concentrations are prognostic following traumatic and anoxic brain injury, and may provide a method to quantify neuronal injury in other populations. We determined the association of admission plasma NSE concentrations with mortality and delirium in critically ill septic patients. Methods Retrospective analysis of 124 patients from a larger sepsis cohort. Plasma NSE was measured in the earliest blood draw at intensive care unit (ICU) admission. Primary outcomes were 30-day mortality and ICU delirium determined by chart review. Results Sixty-one patients (49.2%) died within 30 days and delirium developed in 34 (31.5%) of the 108 patients who survived at least 24 hours and were not persistently comatose. Each doubling of the NSE concentration was associated with a 7.3% (95% CI 2.5–12.0, P = .003) increased risk of 30-day mortality and a 5.2% (95% CI 3.2–7.2, P < .001) increased risk of delirium. An NSE concentration > 12.5ug/L was independently associated with a 23.3% (95% CI 6.7–39.9, P = .006) increased risk of 30-day mortality and a 29.3% (95% CI 8.8–49.8, P = .005) increased risk of delirium. Conclusions Higher plasma NSE concentrations were associated with mortality and delirium in critically ill septic patients, suggesting NSE may have utility as a marker of neuronal injury in sepsis.