Neuron-specific enolase and S-100B are associated with neurologic outcome after pediatric cardiac arrest.
OBJECTIVE
To characterize the pattern of serum biochemical markers of central nervous system injury (neuron-specific enolase [NSE], S-100B, plasminogen activator inhibitor-1 [PAI-1]) after pediatric cardiac arrest and determine whether there is an association between biomarker concentrations and neurologic outcome.


METHODS
Prospective, observational study.


METHODS
Urban, tertiary care children's hospital.


METHODS
Cardiac arrest survivors, n = 35.


METHODS
Serial blood sampling, pediatric cerebral performance category, and standardized neurologic examination.


RESULTS
Serial serum NSE and S-100B concentrations over 96 hrs and PAI-1 at 24 hrs were measured in children (age <18 yrs) who had return of spontaneous circulation following cardiac arrest. Neurologic outcome was prospectively categorized as poor if the change in pre- to postarrest pediatric cerebral performance category was > or =2. Biomarker concentrations were compared between outcome groups and between survival groups using longitudinal analysis correcting for multiple comparisons. Median levels (25th, 75th percentiles) are reported. Receiver operating characteristic analyses were performed at all time points. Biomarker concentrations showed statistically significant differences. Of the 35 patients, neurologic outcomes were poor in 19, with 15 deaths. Median NSE concentrations differed by outcome when measured at > or =48 hrs, and by survival at > or =24 hrs. S-100B concentrations were not significantly associated with neurologic outcome. S-100B levels were associated with survival outcome at > or =48 hrs. PAI-1 levels were not significantly associated with either neurologic or survival outcomes.


CONCLUSIONS
The timing, intensity, and duration of serum NSE and S-100B biomarker concentration patterns are associated with neurologic and survival outcomes following pediatric cardiac arrest. Serum NSE concentrations at > or =48 hrs are associated with neurologic outcome, whereas serum S-100B levels at > or =48 hrs are associated with survival. Prospective analysis of these markers may help to predict outcomes and guide postresuscitative therapies.
Topjian
Alexis A
AA
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. topjian@email.chop.edu
Lin
Richard
R
Morris
Marilyn C
MC
Ichord
Rebecca
R
Drott
Henry
H
Bayer
Carey R
CR
Helfaer
Mark A
MA
Nadkarni
Vinay
V
D015415:Biomarkers; D016887:Cardiopulmonary Resuscitation; D002493:Central Nervous System Diseases / Q000097:blood* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000150:complications* / Q000628:therapy; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009414:Nerve Growth Factors / Q000097:blood*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011379:Prognosis; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D013997:Time Factors
D015415:Biomarkers; D009414:Nerve Growth Factors; D017395:Plasminogen Activator Inhibitor 1; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase