S-100B is superior to NSE, BDNF and GFAP in predicting outcome of resuscitation from cardiac arrest with hypothermia treatment.
OBJECTIVE
To conduct a pilot study to evaluate the blood levels of brain derived neurotrophic factor (BDNF), glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE) and S-100B as prognostic markers for neurological outcome 6 months after hypothermia treatment following resuscitation from cardiac arrest.


METHODS
Prospective observational study.


METHODS
One intensive care unit at Uppsala University Hospital.


METHODS
Thirty-one unconscious patients resuscitated after cardiac arrest.


METHODS
None.


RESULTS
Unconscious patients after cardiac arrest with restoration of spontaneous circulation (ROSC) were treated with mild hypothermia to 32-34°C for 26h. Time from cardiac arrest to target temperature was measured. Blood samples were collected at intervals of 1-108h after ROSC. Neurological outcome was assessed with Glasgow-Pittsburgh cerebral performance category (CPC) scale at discharge from intensive care and again 6 months later, when 15/31 patients were alive, of whom 14 had a good outcome (CPC 1-2). Among the predictive biomarkers, S-100B at 24h after ROSC was the best, predicting poor outcome (CPC 3-5) with a sensitivity of 87% and a specificity of 100%. NSE at 96h after ROSC predicted poor outcome, with sensitivity of 57% and specificity of 93%. BDNF and GFAP levels did not predict outcome. The time from cardiac arrest to target temperature was shorter for those with poor outcome.


CONCLUSIONS
The blood concentration of S-100B at 24h after ROSC is highly predictive of outcome in patients treated with mild hypothermia after cardiac arrest.
Department of Surgical Sciences, Anaesthesia and Intensive Care, Uppsala University, Uppsala University Hospital, Uppsala, Sweden. erik.mortberg@surgsci.uu.se
Erik
E
Mörtberg
Henrik
H
Zetterberg
Johanna
J
Nordmark
Kaj
K
Blennow
Lars
L
Rosengren
Sten
S
Rubertsson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D019208:Brain-Derived Neurotrophic Factor / Q000097:blood*; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006323:Heart Arrest / Q000097:blood* / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D055815:Young Adult
D015415:Biomarkers; D019208:Brain-Derived Neurotrophic Factor; D005904:Glial Fibrillary Acidic Protein; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase