Modeling Serum Biomarkers S100 Beta and Neuron-Specific Enolase as Predictors of Outcome After Out-of-Hospital Cardiac Arrest: An Aid to Clinical Decision Making

Jul 16, 2012
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Authors:
Einav S, Kaufman N, Algur N, Kark JD.
Citation:
J Am Coll Cardiol 2012;60:304-311.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Are S100 beta (S100B) and neuron-specific enolase (NSE) predictive of neurologically-intact survival after out-of-hospital cardiac arrest (OHCA)?

Methods:

S100B and NSE were measured upon admission and 1 and 3 days later in 195 patients (mean age 73 years) brought to the hospital after OHCA. The Cerebral Performance Category (CPC) score was used to assess outcome prior to discharge. CPC scores of 1-2 (minimal to moderate neurological impairment) were considered a good outcome. Scores of 3-5 (severe neurological impairment) or 5 (death) were considered poor outcomes.

Results:

Survival to hospital discharge with a CPC score of 1-2 was 13.3%. Patients with poor outcomes had significantly higher mean S100B levels upon admission and at 1 and 3 days post-OHCA, and significantly higher mean levels of NSE at 1 and 3 days post-OHCA. Among patients who survived to day 3, the only variables that independently predicted good outcomes were a presenting rhythm of ventricular tachycardia/fibrillation and the serum S100B level measured on day 3. The accuracy of clinical variables for predicting outcome was improved by approximately 5% by inclusion of S100B in the predictive model.

Conclusions:

Post-arrest serum S100B levels are useful for predicting neurologically-intact survival after OHCA.

Perspective:

S100B is a protein that is expressed predominantly in astroglial cells, which are as sensitive as neurons to hypoxia. Therefore, S100B levels are a surrogate marker for hypoxic brain injury. Although S100B levels are independently predictive of outcomes after OHCA, their contribution to a predictive model was very modest in this study. It appears that S100B levels are unlikely to have a significant impact on clinical decision making in survivors of OHCA.

Keywords: Neurons, Ventricular Fibrillation, Cardiopulmonary Resuscitation, Patient Discharge, Out-of-Hospital Cardiac Arrest, Tachycardia, Ventricular, Brain Injuries, Biomarkers, Phosphopyruvate Hydratase, Hypoxia, Brain


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