Predictive value of S-100beta and neuron-specific enolase serum levels for adverse neurologic outcome after cardiac surgery.
OBJECTIVE
The aim of this study was to evaluate the time course of S-100beta and neuron-specific enolase serum levels after cardiac surgery and their clinical relevance in predicting postoperative adverse neurologic outcomes; the 2 proteins are only released in peripheral blood in association with nervous system lesions.


METHODS
We neurologically assessed 190 consecutive patients undergoing elective cardiac operations for coronary artery bypass (n = 147), valve replacement (n = 29), or both (n = 14), before as well as after the operation. Postoperative outcome was classified as type I (uncomplicated), type II (confusion, agitation, disorientation, or epileptic seizures), or type III (stroke, stupor, or coma). Levels of S-100beta and neuron-specific enolase were evaluated in venous blood samples drawn preoperatively and then daily in the first 5 postoperative days.


RESULTS
Levels of S-100beta and neuron-specific enolase differed significantly among the 3 groups (type III > type II > type I) throughout the postoperative period and had a diagnostic specificity and specificity of 89% and 79%, respectively, in identifying patients with type III outcome. S-100beta (but not neuron-specific enolase) levels were identified as significant independent predictors for type II and III outcomes (odds ratio 16.2, P <.0004). The same was true for duration of cardiopulmonary bypass (odds ratio 1.02, P <.006).


CONCLUSIONS
Serum levels of S-100beta are reliable markers for adverse neurologic outcomes after cardiac surgery.
Georgiadis
D
D
University Department of Neurology, Cardio-Thoracic Surgery, Jena, Germany. giadis@medizin.uni-halle.de
Berger
A
A
Kowatschev
E
E
Lautenschläger
C
C
Börner
A
A
Lindner
A
A
Schulte-Mattler
W
W
Zerkowski
H R
HR
Zierz
S
S
Deufel
T
T
D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003627:Data Interpretation, Statistical; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D012307:Risk Factors; D009418:S100 Proteins / Q000097:blood*; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase