Significance of NSE and VCAM-1 in children with hand foot mouth disease combined with encephalitis

Hand-foot-mouth disease (HFMD) is caused by enterovirus with high morbidity and mortality once complicated with neural symptoms. Early diagnostic marker for evaluating severity is of critical importance. This study investigated the differential expression of serum or cerebro-spinal fluid (CSF) neuron specific enolase (NSE) and vascular cell adhesion molecule (VCAM)-1, and to elaborate their implication for early diagnosis and prognostic evaluation. The 93 patients were further divided into three groups based on disease conditions, including group A (31 cases without encephalitis), group B (41 cases with encephalitis) and group C (21 severe patients with encephalitis). Meanwhile, the recruited 32 healthy children was assigned as group D. ELISA was used to detect serum and CSF levels of NSE and VCAM-1 levels during acute and recovery stage. ROC analysis was employed to evaluate their significance in diagnosing complications and predicting prognosis. Multi-variable Logistic regression analysis revealed risk factors for disease progression. Both serum and CSF levels of NSE and VCAM-1 were higher with disease severity, and were lower in recovery period compared to acute phase (P<0.05 in all). ROC analysis showed areas for serum/CSF NSE and VCAM-1 in diagnosing HFMD with encephalitis as 0.908/0.866 and 0.958/0.897, plus sensitivity and specificity as 83.87%/75.81%, 90.32%/80.65%, 82.80%/87.10% and 81.72%/83.87%, respectively. Risk factors for HFMD complicated with encephalitis included elevated sensitivity of diagnosis, higher heart rate, and potentiated serum/ACSF levels of NSE or CXAM-1. Serum or CSF levels of NSE and VCAM-1 can reflect the severity of HFMD complicated with encephalitis, and may help to predict severe complications and prognosis.