Can early serum levels of S100B protein predict the prognosis of patients with out-of-hospital cardiac arrest?
OBJECTIVE
This study aims to know if the level of S100B protein at the initiation of cardiopulmonary resuscitation (CPR) and immediately after return of spontaneous circulation (ROSC) can predict clinical outcome.


METHODS
A prospective observational study from December 2004 to October 2006 was conducted in an urban tertiary hospital emergency department. Clinical demographics for out-of-hospital cardiac arrest patients were collected based on the Utstein style. Outcomes collected included ROSC for 20min, survival to admission, survival and Glasgow Outcome Scale (GOS) at 1 month. S100B protein was measured twice before starting CPR (first S100B) and immediately after ROSC (second S100B). We investigated the association between S100B protein levels and clinical outcomes using a multivariate logistic regression model.


RESULTS
A total of 151 patients were included (age: 60.2+/-16.8 years, male: 64.2%). Of these, 60 (39.7%) had ROSC and 46 (30.5%) survived to admission. After 1 month, 12 (8.0%) survived and only three patients showed good GOS (>/=4 points). The S100B levels were not different for ROSC, survival to admission and 1-month survival between survivors and non-survivors (p>0.05, first and second S100 B level). For the witnessed out-of-hospital cardiac arrest (OHCA) group (N=87), only the first S100B (1.22+/-0.85mugl(-1) vs. 3.91+/-4.25mugl(-1), p<0.001) showed significant difference for 1-month survival between survivors and non-survivors. The first S100B showed significant association with survival to emergency department (ED) but not 1-month survival (adjusted odds ratio (OR)=0.905, 95% confidence interval=0.821-0.998).


CONCLUSIONS
Higher levels of S100B at start of CPR were significantly associated with lower survival to admission, and not for 1-month survival.
Song
Kyoung Jun
KJ
Seoul National University College of Medicine, 101 Daehak-Ro, Chongno-Gu, Seoul 110-744, Republic of Korea. doctorsong@paran.com
Shin
Sang Do
SD
Ong
Marcus Eng Hock
ME
Jeong
Joong Sik
JS
D000328:Adult; D000368:Aged; D003326:Coronary Circulation; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D010045:Outpatients; D010343:Patient Admission; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human