Neuron specific enolase and S-100B as predictors of outcome after cardiac arrest and induced hypothermia.
OBJECTIVE
To assess the prognostic value of repetitive serum samples of neuron specific enolase (NSE) and S-100B in cardiac arrest patients treated with hypothermia.


METHODS
In a three-centre study, comatose patients after cardiac arrest were treated with hypothermia at 33 degrees C for 24h, regardless of cause or the initial rhythm. Serum samples were collected at 2, 24, 48 and 72h after the arrest and analysed for NSE and S-100B in a non-blinded way. The cerebral performance categories scale (CPC) was used as the outcome measure; a best CPC of 1-2 during 6 months was regarded as a good outcome, a best CPC of 3-5 a poor outcome.


RESULTS
One centre was omitted in the NSE analysis due to missing 24 and 48h samples. Two partially overlapping groups were studied, the NSE group (n=102) and the S-100B group (n=107). NSE at 48h >28microg/l (specificity 100%, sensitivity 67%) and S-100B >0.51microg/l at 24h (specificity 96%, sensitivity 62%) correlated with a poor outcome, and so did a rise in NSE of >2microg/l between 24 and 48h (odds ratio 9.8, CI 3.5-27.7). A majority of missing samples (n=123) were from the 2h sampling time (n=56) due to referral from other hospitals or inter-hospital transfer.


CONCLUSIONS
NSE was a better marker than S-100B for predicting outcome after cardiac arrest and induced hypothermia. NSE above 28microg/l at 48h and a rise in NSE of more than 2microg/l between 24 and 48h were markers for a poor outcome.
Rundgren
Malin
M
Department of Anaesthesia and Intensive Care, Lund University Hospital, Sweden. malin.rundgren@skane.se
Karlsson
Torbjörn
T
Nielsen
Niklas
N
Cronberg
Tobias
T
Johnsson
Per
P
Friberg
Hans
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002648:Child; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000201:enzymology* / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase