Abstract 311: Early Evaluation Biomarkers-Based of Neurological Prognosis in Hypothermic Post--Cardiac Arrest Patients

Abstract

Early prognosis of neurological outcome in patients resuscitated from cardiac arrest (CA) is a major medical challenge. High serum levels of both serum neuron-specific enolase (NSE) and S-100B protein are related with brain damage, but the relationship with neurological outcome at hospital discharge, in hypothermic post CA patients, is uncertain. The aim of this study was to evaluate the prognostic value and cut-off values of NSE and S-100B protein in predicting neurological outcome in comatose patients after CA treated with therapeutic hypothermia (TH). Methods: We enrolled consecutive patients, between November 2010 and May 2012. NSE and S-100B values were sampled at admission and every 24 hours since discharge from intensive care unit. According to Cerebral Performance Category (CPC) scale, neurological outcome was dichotomized into good (CPC 1-2) or poor (CPC 3-5). Results: thirty-one patients (25 males; mean age 60±15years). Twenty patients had a favourable outcome. Median values of serum NSE peak and S-100B peak were 25 ug/L (interquartile range, 20.8 to 43.3 ug/L) and 0.3 ug/L (range, 0.15 to 0.7 ug/L) respectively. High peak values of NSE and S-100B were significantly associated with poor neurological outcome (p=0.015 and p=0.007 respectively). Using a regression tree model we found worst neurological recovery for NSE peak value above 64.7 ug/L or S-100B above 0.65 ug/L (p=0.01 and p=0.007 respectively). Good neurological outcome was associated with NSE peak value less than 40.5 ug/L (p=0.012) especially if S-100B was less than 0.23 ug/L (p=0.031) (figure). Conclusion: Serum peak concentrations of NSE and S-100B result to be highly predictive of neurological outcome, especially when combined. Moreover, our data demonstrate that a good neurological outcome is associated with NSE peak value minor than 40.5 ug/L especially with S-100B minor than 0.23 ug/L. On this basis, determination of NSE and S-100B peak values may be useful in the early evaluation of prognostic neurological outcome to guide clinical decision making, in hypothermic post CA patients.