目的:本研究旨在探讨脓毒症相关性脑病(SAE)患者血清神经元特异性烯醇化酶(NSE)水平,并进行meta分析以评估血清NSE在SAE患者中的诊断和预后潜力。
方法:我们在英文和中文数据库中搜索了与SAE相关的研究,这些研究报告了血清NSE水平,直至2023年11月。我们从这些研究中提取了信息,包括第一作者和发表年份,样品的数量,患者的性别和年龄,患者血液样本的采集时间,血清NSE的测定方法,研究方法,和以ng/mL为单位的血清NSE水平。诊断准确性研究2(QUADAS-2)的质量评估工具用于评估研究质量。使用ReviewManager5.3版进行荟萃分析,采用随机效应模型或固定效应模型。
结果:共有17项研究被纳入最终的meta分析,包括682例SAE患者和946例NE患者。荟萃分析显示,SAE患者的血清NSE水平明显高于NE患者(Z=5.97,P<0.001,MD=7.79,95CI5.23-10.34),与血清NSE检测方法(Z=6.15,P<0.001,均差[MD]=7.75,95CI5.28-10.22)和研究方法(Z=5.97,P<0.001,MD=7.79,95CI5.23-10.34)无关。此外,与预后不良(死亡或神经系统不良结局)的患者相比,预后良好的脓毒症患者的血清NSE水平显著降低(Z=5.44,P<0.001,MD=-5.34,95CI-7.26-3.42).
结论:SAE患者血清NSE水平明显高于无脑病的脓毒症患者。SAE患者血清NSE水平越高,他们的死亡率和神经系统不良结局的发生率越高。
OBJECTIVE: This study aimed to investigate the serum levels of neuron-specific enolase (NSE) in sepsis-associated encephalopathy (SAE) and perform a meta-analysis to assess the diagnostic and prognostic potential of serum NSE in SAE patients.
METHODS: We searched English and Chinese databases for studies related to SAE that reported serum NSE levels until November 2023. We extracted information from these studies including the first author and year of publication, the number of samples, the gender and age of patients, the collection time of blood samples in patients, the assay method of serum NSE, the study methods, and the levels of serum NSE with units of ng/mL. The quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tool was used to evaluate the study quality. A meta-analysis was performed using Review Manager version 5.3, employing either a random effects model or a fixed effects model.
RESULTS: A total of 17 studies were included in the final meta-analysis, including 682 SAE patients and 946 NE patients. The meta-analysis demonstrated significantly higher serum NSE levels in SAE patients compared to NE patients (Z = 5.97, P < 0.001, MD = 7.79, 95%CI 5.23-10.34), irrespective of the method used for serum NSE detection (Z = 6.15, P < 0.001, mean difference [MD] = 7.75, 95%CI 5.28-10.22) and the study methods (Z = 5.97, P < 0.001, MD = 7.79, 95%CI 5.23-10.34). Furthermore, sepsis patients with a favorable outcome showed significantly lower levels of serum NSE compared to those with an unfavorable outcome (death or adverse neurological outcomes) (Z = 5.44, P < 0.001, MD = - 5.34, 95%CI - 7.26-3.42).
CONCLUSIONS: The Serum level of NSE in SAE patients was significantly higher than that in septic patients without encephalopathy. The higher the serum NSE level in SAE patients, the higher their mortality rate and incidence of adverse neurological outcomes.