Correlation between brain injury biomarkers and Glasgow coma scale in pediatric sepsis

Main Article Content

Nahari Arifin
Irawan Mangunatmadja
Antonius Pudjiadi
Sudung O. Pardede


Background Sepsis in children, with or without multiple organ
failure, causes increased susceptibility to brain injury due to
systemic insults. Brain injury in sepsis is difficult to recognize
clinically. Neuron-specific enolase (NSE) and S-lOOB have been
extensively studied in brain injuries and appear to be promising
alternative biomarkers.
Objectives To determine if there is a correlation between the
Glasgow coma scale (GCS) and NSE as well as S-lOOB levels, in
children with sepsis.
Methods We performed an analytical study on septic children
aged > 2 years. GCS scores were assessed on the first and third
days of admission. Blood specimens to test for NSE and S-lOOB
were drawn on the first day of admission and stored at -70QC for
further analysis at the end of the study.
Results Out of 35 patients, 30 met the inclusion criteria. Postanalysis,
one subject with NSE above the maximum level was
excluded. Negative correlations were found between GCS score
and NSE, as well as between GCS and S-lOOB levels. Analysis
revealed a significant ROC for NSE, but not for S-lOOB. NSE
concentration of 8.1 /.lg/L was the cut-off point for GCS scores
below 12.
Conclusions There were negative correlations between GCS
and NSE levels, as well as between GCS and S- lOOB levels. The
predictive value ofNSE level was a cut-off point of 8.1 /.lg/L for
GCS scores below 12. [Paediatr lndones. 2012;52:111-17]

Article Details

How to Cite
Arifin N, Mangunatmadja I, Pudjiadi A, Pardede S. Correlation between brain injury biomarkers and Glasgow coma scale in pediatric sepsis. PI [Internet]. 30Apr.2012 [cited 15Aug.2020];52(2):111-7. Available from:
Received 2016-08-22
Accepted 2016-08-22
Published 2012-04-30


1. Center for Disease Control. Increase in national hospital
discharge survey rates for septicemia: United States 1979 -
1987. Morb Mortal Wkly Rep. 1990;39:31-4.
2. American College of Chest Physician I Society of Critical
Care Medicine Consensus Conference. Definitions for sepsis
and organ failure and guidelines for the use of innovative
therapies in sepsis. Crit Care Med. 1992;20:864-74.
3. Balk RA. Severe sepsis and septic shock: definition,
epidemiology, and clinical manifestations. Crit Care Clin.
2000; 16:179-92.
4. Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G,
Lidicker J, Angus DC. The epidemiology of severe sepsis in
children in the United States. Am J Respir Crit Care Med.
2003; 167:695-701.
5. Goldstein B, Giroir B, Randolph A. International pediatric
sepsis consensus conference: definitions for sepsis and
organ dysfunction in pediatrics. Pediatr Crit Care Med.
6. Sprung CL, Peduzzi PN, Shatney CH, Schein RM, Wilson MF,
Sheagren JN, et al. Impact of encephalopathy on mortality
in the sepsis syndrome. The Veterans Administration
Systemic Sepsis Cooperative Study Group. Crit Care Med.
1990; 18:801-6.
7. Hsu AA, Fenton K, Weinstein S, Carpenter J, Dalton H,
Bell MJ. Neurological injury markers in children with septic
shock. Pediatr Crit Care Med. 2008;9:245-51.
8. Hellstrom-Westas L. Continuous electroencephalography
monitoring of the preterm infant. Clin Perinatol. 2006;
9. Mewasingh LD, Christophe C, Fonteyne C, Dachy
B, Ziereisen F, Christiaens F, et al. Predictive value of
electrophysiology in children with hypoxic coma. Pediatr
Neurol. 2003;28:178-83.
10. Sharshar T, Carli er R, Bernard F, Guidoux C, Brouland JP, Nardi
0, et al. Brain lesions in septic shock: a magnetic resonance
imaging study. Intensive Care Med. 2007;33:798-806.
11. Berger RP, Pierce MC, Wisniewski SR, Adelson PD, Clark
RS, Ruppel RA, et al. Neuron-specific enolase and SlOOB
in cerebrospinal fluid after severe traumatic brain injury in
infants and children. Pediatrics. 2002; 109:31-7.
12. Topjian M, Lin R, Morris MC, !chord R, Drott H, Bayer
CR, et al. Neuron-specific enolase and S-lOOB are associated
with neurologic outcome after pediatric cardiac arrest. Pediatr
Crit Care Med. 2009;10:479-90.
13. NguyenDN, Spapen H, Su F, SchiettecatteJ, ShiL, HachimiIdrissi
S, et al. Elevated serum levels of S-100 beta protein
and neuron-specific enolase are associated with brain injury
in patients with severe sepsis and septic shock. Crit Care
Med. 2006;34: 1967-74.
14. Eidelman LA, Putterman D, Putterman C, Sprung CL. The
spectrum of septic encephalopathy. Definitions, etiologies,
and mortalities. JAMA 1996;275 :4 70-3.
15. Ebersoldt M, Sharshar T, Annane D. Sepsis-associated
delirium. Intensive Care Med. 2007;33:941-50.
16. Young GB, Bolton CF, Archibald YM, Austin TW, Wells
GA. The electroencephalogram in sepsis-associated
encephalopathy.} Clin Neurophysiol. 1992;9:145-52.
1 7. Bottiger BW, Mobes S, Glatzer R, Bauer H, Gries A, Bartsch
P, et al. Astroglial protein S-100 is an early and sensitive
marker of hypoxic brain damage and outcome after cardiac
arrest in humans. Circulation 2001; 103 :2694-8.
18. Sharshar T, Hopkinson N, Orlikowski 0, Annane D. Science
review: the brain in sepsis - culprit and victim. Crit Care.
19. Tiainen M, Roine RO, Pettila V, Takkunen 0. Serumneuronspecific
enolase and S- lOOB protein in cardiac arrest patients
treated with hypothermia. Stroke. 2003;34:2881-6.
20. Berger RP, Adelson PD, Richichi R, Kochanek PM. Serum
biomarkers after traumatic and hypoxemic brain injuries:
insight into the biochemical response of the pediatric brain
to inflicted brain injury. Dev Neurosci. 2006;28:327-35.
21. Guan W, Yang YI, Xia WM. Significance of serum neuronspecific
enolase in patients with acute traumatic brain injury.
Chin J Traumatol. 2003;6: 218-21
22. Ross SA, Cunningham RT, Johnston CF. Neuron-specific
enolase as an aid to outcome prediction in head injury. Br J
Neurosurg. 1996;10:471-6.
23 . Elting JW, De Jager AE, Teelken AW. Comparison of serum
SlOO protein levels following stroke and traumatic brain
injury. J N eurol Sci. 2000; 181: 104-10.
24. Rundgren M, Torbjorn K, Nielsenc N, Cronbergd T,
Johnssone P, FribergfH. Neuron specificenolase and S-lOOB
as predictors of outcome after cardiac arrest and induced
hypothermia. Resuscitation. 2009;80:784-9
25. Redl H, Pelinka L, Bahrami S, Boltzmann L. To be or not to
be-a biomarker of brain damage in sepsis (review). Pediatr
Crit Care 2008;9:337-8.