Cerebral complications after cardiac surgery assessed by S-100 and NSE levels in blood.
OBJECTIVE
Assessment of the value of blood analysis of the astroglia protein, S-100, and neuron-specific enolase for the detection of nervous system dysfunction after cardiac surgery.


METHODS
Prospective study. Neurologists blinded from laboratory results.


METHODS
University hospital.


METHODS
38 patients undergoing cardiac surgery.


METHODS
21 patients were operated for coronary artery disease; seven patients with replacement of the aortic valve of whom 2 also had coronary bypass. Four patients had mitral valve replacement of whom 2 also had coronary bypass. One patient had both aortic and mitral valve replacement and coronary bypass. Two patients were operated on because of aortic arch aneurysm.


RESULTS
Neurologic examinations were performed before and after surgery. General behavior of the patients was repeatedly assessed. Blood samples for analysis were collected before operation and on the second day after surgery. In 8/38 patients (21%), a neurologic complication, one of which was lethal, occurred. In 27 patients (71%), the neurologic outcome was uncomplicated, and in 3 (8%), it could not be classified. Elevated S-100 and neuron-specific enolase levels were found in 7/8 patients who endured a neurologic complication and in 4/27 free of complication. (Fisher's exact test p < 0.001). Positive and negative predictive values were 64% and 96%, respectively. S-100 (range 0.5 to 1.3 micrograms/L) and neuron-specific enolase levels (range 8.6 to 16.7 micrograms/L) were lower for the 7 patients with nonlethal complications than for the patient who died (9.5 micrograms/L and 31.3 micrograms/L, respectively).


CONCLUSIONS
S-100 and neuron-specific enolase levels after cardiac surgery are associated with neurologic complications. The results have implications on patient-related treatment and prognosis as well as for the development of safer perfusion techniques.
Johnsson
P
P
Department of Cardiothoracic Surgery, Lund University Hospital, Sweden.
Lundqvist
C
C
Lindgren
A
A
Ferencz
I
I
Alling
C
C
Ståhl
E
E
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery; D001519:Behavior; D001927:Brain Diseases / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D009418:S100 Proteins / Q000097:blood*; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D015996:Survival Rate
D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase