A prospective study of plasma NSE levels to predict ICU mortality in patients with severe community-ac-quired pneumonia
Objective To investigate the predictive value of Neuron-Specific Enolase(NSE)levels at different time points for ICU mortality in patients with Severe Community-Acquired Pneumonia(SCAP).Methods Seventy-four SCAP patients admitted to the Emergency Intensive Care Unit(EICU)of Hebei General Hospital from June 2021 to June 2023 were selected.Blood samples for neutrophil count,serum creatinine(Scr),albumin(Alb),procalcitonin(PCT),C-reactive protein(CRP),serum amyloid A(SAA),and interleukin-6(IL-6)levels were examined within 12 hours of admission.The blood samples of NSE were collected and evaluated in the mornings of the first[NSE(dayl)]and the fourth day[NSE(day4)]after admission.Patients were divided into a sur-vival group(n=57)and a non-survival group(n=17)based on wheth-er they died in the EICU.Multivariate logistic regression analysis,re-ceiver operating characteristic(ROC)curve and area under the curve(AUC)were performed to evaluate the predictive effects of the above parameters.Results There were no statistically significant dif-ferences in age and gender between the two groups(P＞0.05).The non-survival group had higher Acute Physiology and Chronic Health Evaluation Ⅱ score(APACHE Ⅱ score),IL-6,neutrophil counts,NSE(day1)and NSE(day4)than the survival group(P＜0.05)and the oxygenation index(PaO2/FiO2)was significantly lower in the non-survival group(P＜0.05).There was no significant difference in the number of patients receiving mechanical ventilation between the two groups(P＞0.05).APACHE Ⅱ score,IL-6 levels,neutrophil count,NSE(day1)and NSE(day4)levels were weakly positively correlated with ICU mortality in SCAP patients(P＜0.05),while PaO2/FiO2 was weakly negatively correlated with ICU mortality(P＜0.05).Multivariate logistic regression analysis showed that APACHE Ⅱ score[odds ratio(OR)=1.237,95％confidence interval(CI)1.017-1.505,P=0.033],and NSE(day4)(OR=1.147,95％CI 1.034-1.273,P=0.010)were related to ICU mortality in SCAP patients.The AUCs of APACHE Ⅱ score and NSE(day4)for predicting ICU mortality in SCAP patients were 0.729(95％CI 0.613-0.826)and 0.787(95％CI 0.676-0.874)respectively,with no sta-tistically different(P=0.561).The sensitivity and specificity of NSE(day4)in predicting ICU mortality were 57.89％and 88.24％re-spectively,with a cut-off value of 14.84 μg/L.Conclusion NSE(day4)is an independent predictor of ICU mortality in SCAP pa-tients and serves as an alternative choice for assessing the prognosis of SCAP patients.
neuron-specific enolasesevere community-acquired pneumoniaemergency intensive care unitprognosis
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