Abstract
Objective: Postoperative cognitive dysfunction (POCD) can feature a wide spectrum of clinical symptoms, from asymptomatic to debilitating dementia, that lead to increased dependence, lower quality of life, morbidity, and mortality. Protein S100B is a direct marker for neuronal cell damage. We aimed to evaluate S100B as a biomarker for predicting POCD following open-heart surgery.
 Methods: This was an observational-analytic study to assess changes of the S100B level following open-heart surgery in Cipto Mangunkusumo Hospital, Jakarta. All subjects underwent cognitive function evaluations that consisted of six psychometric tests on the day prior to surgery and five days after surgery. Cognitive dysfunction was determined if there was a>20% cognitive score drop from baseline values in at least two tests. Blood samples for S100B were obtained (1) before the induction of anesthesia and (2) six hours after surgery. Samples were analyzed using enzyme-linked immunosorbent assay for S100B. All data were analyzed using SPSS 20.
 Results: Among the 55 subjects analyzed, 31 (56.4%) were found to have a decline in cognitive function. There were no differences in baseline characteristics, comorbidities, and perioperative data. Oxygen contents also did not show significant differences at any time. The S100B levels in all subjects increased. This increase was>1.5x higher in subjects with POCD compared to those without POCD (2.15[0.22–60.03] vs. 1.33[0.15–19.77] ng/ml, p = 0.16). However, this difference was not statistically significant.
 Conclusion: This study showed that serum S100B is higher in POCD patients and has the potential to be a biomarker for predicting POCD after open-heart surgery.
Highlights
Postoperative cognitive dysfunction (POCD) can feature a wide spectrum of clinical symptoms, from asymptomatic to debilitating dementia
We aim to evaluate the value of S100B as a biomarker for predicting POCD following open-heart surgery
Of the 55 subjects included in this study, 31 (56.4%) suffered POCD
Summary
Postoperative cognitive dysfunction (POCD) can feature a wide spectrum of clinical symptoms, from asymptomatic to debilitating dementia. POCD prevalence can be as high as 40%, with that number rising to up to 50% following open-heart surgery. A 2017 study in our hospital showed that the prevalence of POCD following openheart surgery was 40.7% [4]. Cardiopulmonary bypass (CPB) in open-heart surgery triggers a cascade of inflammatory events and their consequences. This process is inevitable as synthetic CPB material comes into contact with human cells [6]. Hemodynamic management during CPB may contribute to oxygen delivery to tissues. There is no method for assessing the efficacy of oxygen delivery and uptake in tissue. The inadequacy of oxygen delivery and uptake in brain tissues may trigger neuronal brain damage
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