title: Modeling serum level of s100β and bispectral index to predict outcome after cardiac arrest.
abstract: OBJECTIVE
  This study was designed to evaluate multimodal prognostication in patients after cardiac arrest (CA).
  
  
  BACKGROUND
  Accurate methods to predict outcome after CA are lacking.
  
  
  METHODS
  Seventy-five patients with CA treated with therapeutic hypothermia after cardiac resuscitation were enrolled in this prospective observational study. Serum levels of neuron-specific enolase (NSE) and neuron-enriched S100 beta (S100β) were measured 48 h after CA. Bispectral index (BIS) was continuously monitored during the first 48 h after CA. The primary endpoint was neurological outcome, as defined by the cerebral performance category (CPC) at 6-month follow-up: scores 1 or 2 indicated good outcome, and scores 3 to 5, poor outcome. The secondary endpoint was survival.
  
  
  RESULTS
  A total of 46 (61%) patients survived at 6 months and 41 (55%) patients had CPC 1 or 2. Levels of NSE and S100β were higher in patients with poor outcomes compared with patients with good outcomes (4-fold and 10-fold, respectively; p < 0.001). BIS was lower in patients with poor outcomes (10-fold; p < 0.001). NSE, S100β, or BIS alone predicted neurological outcome, with areas under the receiver-operating characteristic curve (AUC) above 0.80. Combined determination of S100β and BIS had an incremental predictive value (AUC: 0.95). S100β improved discriminations based on BIS (p = 0.0008), and BIS improved discriminations based on S100β (p < 10(-5)). Patients with S100β level above 0.03 μg/l and BIS below 5.5 had a 3.6-fold higher risk of poor neurological outcome (p < 0.0001). S100β and BIS predicted 6-month mortality (log-rank statistic: 50.41; p < 0.001).
  
  
  CONCLUSIONS
  Combined determination of serum level of S100β and BIS monitoring accurately predicts outcome after CA.
authors.affiliation: Department of Anaesthesia and Intensive Care, Centre Hospitalier, Luxembourg, Luxembourg.
authors.forename: Pascal
authors.initials: P
authors.lastname: Stammet
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Wagner
authors.forename: Georges
authors.initials: G
authors.lastname: Gilson
authors.forename: Yvan
authors.initials: Y
authors.lastname: Devaux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001921:Brain / Q000503:physiopathology*; D056805:Consciousness Monitors; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000097:blood* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012151:Resuscitation; D012307:Risk Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D010751:Phosphopyruvate Hydratase
keywords: BIS; CA; CPC; EEG; ICU; IDI; NSE; ROSC; S100β; SAPS; biomarkers; bispectral index; brain injury; cardiac arrest; cerebral performance category; electroencephalogram; electroencephalography; integrated discrimination improvement; intensive care unit; neuron-enriched S100 beta; neuron-specific enolase; prognosis; return of spontaneous circulation; simplified acute physiology score; survival