Serum Neuron-Specific Enolase and Associated Biochemical Markers in Traumatic Spinal Cord Injury: A Case-Control Study

Abstract

Abstract 

Background: Traumatic spinal cord injury (tSCI) is associated with early neural tissue disruption, systemic inflammation, metabolic stress, and variable neurological outcomes. Although neurological examination and imaging remain central to diagnosis, blood-based biomarkers may provide an additional biochemical window into the acute injury state. Neuron-specific enolase (NSE) has been proposed as a candidate marker of neuronal injury; however, its interpretation is strengthened when assessed alongside inflammatory, enzymatic, hematological, and metabolic indicators.

Objective: This study aimed to evaluate serum NSE and selected biochemical markers in patients with TSCI compared with healthy controls, and to examine their discriminatory performance using comparative statistics, correlation analysis, logistic regression, and receiver operating characteristic (ROC) analysis.

Methods: This case-control study included 60 patients with clinically and radiologically confirmed TSCI and 60 healthy controls. Blood samples were obtained during the early post-admission period. Serum NSE, creatine kinase (CK), lactate dehydrogenase (LDH), C-reactive protein (CRP), glucose, white blood cell (WBC) count, and hemoglobin (Hb) were analyzed. Group comparisons were performed according to data distribution, and diagnostic discrimination was assessed by ROC analysis using Youden-derived cut-off values.

Results: The TSCI and control groups were comparable with respect to age, body mass index, and sex distribution. Patients with TSCI demonstrated a distinct acute biochemical profile, with significantly higher NSE, LDH, CRP, CK, WBC count, and glucose levels, together with significantly lower Hb concentration. ROC analysis showed excellent discriminatory performance for all evaluated biomarkers. LDH achieved the highest area under the curve (AUC = 0.997; cut-off >245 U/L; sensitivity 98.3%; specificity 98.3%), followed by NSE (AUC = 0.978; cut-off >30.0 ng/mL; sensitivity 96.7%; specificity 95.0%). CK and CRP also showed strong discrimination, with AUC values of 0.928 and 0.936, respectively. Within the TSCI group, NSE correlated positively with LDH, WBC, CRP, and CK, and negatively with Hb, suggesting that the neurochemical signal occurred within a broader inflammatory and systemic injury response. particularly when interpreted alongside complementary biochemical markers, including LDH, CRP, CK, WBC, Hb, and glucose.

Conclusion: Serum NSE is a promising neurochemical biomarker for differentiating patients with traumatic TSCI from healthy controls, particularly when interpreted alongside complementary biochemical markers includes LDH, CRP, CK, WBC, Hb, and glucose. However, because the comparison group consisted of healthy individuals rather than trauma controls, the high ROC performance should be interpreted as case-control discrimination rather than evidence of trauma-specific diagnostic accuracy. validation in larger cohorts, trauma-control groups, serial sampling designs, and outcome-linked models is required before routine clinical translation.