Combination of S100B and procalcitonin improves prognostic performance compared to either alone in patients with cardiac arrest: A prospective observational study

Jae Ho Jang, Won Bin Park, Yong Su Lim, Jea Yeon Choi, Jin Seong Cho, Jae-Hyug Woo, Woo Sung Choi, Hyuk Jun Yang, Sung Youl Hyun, Jae Ho Jang, Won Bin Park, Yong Su Lim, Jea Yeon Choi, Jin Seong Cho, Jae-Hyug Woo, Woo Sung Choi, Hyuk Jun Yang, Sung Youl Hyun

Abstract

This study aimed to determine whether the combination of procalcitonin (PCT) and S100B improves prognostic performance compared to either alone in cardiac arrest (CA) patients treated with targeted temperature management (TTM).We performed a prospective cohort study of CA patients treated with TTM. PCT and S100B levels were obtained at 0, 24, 48, and 72 hours after return of spontaneous circulation. The prognostic performance was analyzed using each marker and the combination of the 2 markers for predicting poor neurological outcome at 3 months and mortality at 14 days and 3 months.A total of 97 patients were enrolled, of which 67 (69.1%) had poor neurological outcome. S100B showed a better prognostic performance (area under the curve [AUC], 0.934; sensitivity, 77.6%; and specificity, 100%) than PCT (AUC, 0.861; sensitivity, 70.2%; and specificity, 83.3%) with the highest prognostic value at 24 hours. The combination of 24-hour PCT and S100B values (S100B ≥0.2 μg/L or PCT ≥6.6 ng/mL) improved sensitivity (85.07%) compared with S100B alone. In multivariate analysis, PCT was associated with mortality at 14 days (odds ratio [OR]: 1.064, 95% confidence interval [CI]: 1.014-1.118), whereas S100B was associated with neurological outcomes at 3 months (OR: 9.849, 95% CI: 2.089-46.431).The combination of PCT and S100B improved prognostic performance compared to the use of either biomarker alone in CA patient treated with TTM. Further studies that will identify the optimal cutoff values for these biomarkers must be conducted.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Release pattern for (A) PCT and (B) S100B protein after return of spontaneous circulation in the good and the poor outcome group. Data are presented in median and 95% confidence interval. #P = .003, ∗P < .001. CPC = cerebral performance category, PCT = procalcitonin.
Figure 2
Figure 2
Comparison of ROC curve of PCT and S100B at 0, 24, 48, and 72 hours for predicting poor neurological outcome. (A) AUC for procalcitonin. (B) AUC for S100B protein. AUV = area under the curve, CPC = cerebral performance category, PCT = procalcitonin.
Figure 3
Figure 3
A scatter plot depicting the relationship between PCT and S100B protein according neurological outcome at 24 hours after return of spontaneous circulation. Line indicates 100% specific cutoff values of PCT (6.6 ng/mL) and S100B protein (0.2 μg/L). PCT = procalcitonin.

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