Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale.
OBJECTIVE
Patients resuscitated from cardiac arrest are at risk of subsequent death or poor neurological outcome up to a persistent vegetative state. We investigated the prognostic value of several epidemiological and clinical markers and two neuroproteins, neuron-specific enolase (NSE) and S-100 protein (S-100), in 97 patients undergoing cardiopulmonary resuscitation (CPR) after non-traumatic cardiac arrest between 1998 and 2002.


RESULTS
52.6% of the patients died, 28.8% survived with severe, moderate or without neurological disorders, and 18.6% remained in a persistent vegetative state. Unconsciousness>48 h after CPR predicted a 60.6-fold (95% CI 14.3287-257.205, p=0.001) and a Glasgow Coma Scale (GCS)<6 points after 72 h a 11.2-fold (CI 95%, 3.55-36.44, p<0.001) risk of poor neurological outcome. Serum levels>or=65 ng/ml for NSE and >or=1.5 microg/l for S-100 increased the risk of death and persistent vegetative state 16.8 (95% CI 2.146-131.520)- and 12.6 (95% CI 1.1093-99.210)-fold, respectively. By combination of the GCS with elevated serum concentrations of both neuroproteins above the cut off levels on third day after CPR a poor neurological outcome was predicted with a specificity of 100%.


CONCLUSIONS
The combination of GCS with the serum levels of both neuroproteins at 72 h after CPR permit a more reliable prediction of outcome in post arrest coma than the single markers alone, independent of the application of anaesthetic agents.
Pfeifer
Rüdiger
R
Department of Internal Medicine I, Division of Cardiology and Intensive Care Medicine, University of Jena, Erlanger Allee 101, D-07740 Jena, Germany. Ruediger.Pfeifer@med.uni-jena.de
Börner
Angelika
A
Krack
Andreas
A
Sigusch
Holger H
HH
Surber
Ralf
R
Figulla
Hans R
HR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001925:Brain Damage, Chronic / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D002545:Brain Ischemia / Q000097:blood / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000097:blood* / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D009418:S100 Proteins / Q000097:blood*; D016019:Survival Analysis
D015415:Biomarkers; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase