Serum S100B protein as a prognostic biomarker for neurological outcome after in-hospital cardiac arrest in children

Abstract

Background Survivors of cardiac arrest often require lengthy intensive care admission, rehabilitation, and ongoing treatment of chronic complications as a result of poor function outcomes. S100B protein has emerged as a candidate peripheral biomarker of blood–brain barrier permeability and central nervous system injury. Aim This study aimed to evaluate the serum levels of S100B protein as a prognostic biomarker for predicting neurological outcome after in-hospital cardiac arrest and cardiopulmonary resuscitation (CPR) in children.Patients and methods Thirty infants and children underwent CPR after in-hospital cardiac arrest; blood samples for the evaluation of S100B were drawn after 1 and 24 h after initiation of CPR. Neurological assessment for survivors was done 6 months after cardiac arrest using the cerebral performance category (CPC) score, which was used also immediately following CPR for all patients (including those who died 24 h after CPR). Fifteen healthy children were enrolled as a control group.Results There was highly significant increase of serum S100B protein in postarrest patients at 1 and 24 h as compared with the control group (P<0.001); significant increase in patients at 1 h as compared with patients at 24 h (P<0.05); and highly significant increase of serum S100B protein in dead patients (n=25) as compared with survivors (n=5) (P<0.001). There was highly significant positive correlation between the duration of CPR and the CPC score and S100B protein level (P<0.001).The cutoff value of S100B protein at 1 h (as a prognostic biomarker) was 1430 ng/l with 76% sensitivity and 94% specificity, whereas the cutoff value of S100B protein at 24 h was 227 ng/l with 75% sensitivity and 91% specificity.Conclusion S100B protein was potentially useful as a prognostic biomarker (with high sensitivity and specificity) for neurological outcome after cardiac arrest, as its levels significantly correlated with CPC score of the survivors 6 months after cardiac arrest and with the duration of CPR.