Combining NSE and S100B with clinical examination findings to predict survival after resuscitation from cardiac arrest

Abstract

Background: Neuron specific enolase (NSE) and astroglial protein S100B are associated with outcome following resuscitation from cardiac arrest. We tested whether NSE and S100B levels are associated with illness severity on hospital arrival, and whether levels are independently associated with survival to hospital discharge after adjusting for initial illness severity.

Methods: Levels of NSE and S100B were obtained at arrival, 6, 12, 24, 48, and 72h after successful resuscitation from cardiac arrest. Clinical data included demographics, Pittsburgh Cardiac Arrest Category (PCAC I-IV) and survival to hospital discharge. Univariable and multivariable predictive models including NSE and S-100B were created to predict survival. ROC analyses were performed to determine sensitivity and specificity of NSE and S-100B at each time interval.

Results: Of 77 comatose subjects, 5 did not receive therapeutic hypothermia and were excluded. Mean age was 59 (SD 16) years, with 58% male (N=42), 72% out-of-hospital arrest (N=52), and 43% VF/VT. Survival was 36% (N=26). PCAC IV was associated with higher levels of NSE at 24h (p=0.001) and S100B at 24h (p=0.005). In the multivariate analysis, survival was associated with initial S100B level (OR 0.24; 95% CI 0.07-0.86). NSE values>49.5ng/mL at 48h and NSE values>10.59ng/mL at 72h predicted mortality. S100B levels>0.414ng/mL at 72h predicted mortality.

Conclusions: More severe neurologic injury on initial examination is associated with higher levels of NSE and S100B. Elevated levels of S100B immediately following resuscitation were associated with death. Persistently elevated levels of NSE and S100B at 48 and 72h were associated with death.

Keywords: Biomarkers; Cardiac arrest; Hypothermia; Outcome; Prognostication.

Conflict of interest statement

Conflict of Interest

The authors have no conflict of interest to report.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Serum NSE stratified by PCAC. Values are means. Number of subjects at each time point is delineated below the time point. (*different from PCAC II and PCAC III, p

Figure 2

a. Serum NSE level by PCAC in subjects who died. Values are means. Number of subjects at each time point is delineated below the time point. b. Serum NSE level by PCAC in subjects who survived. Values are means. Number of subjects at each time point is delineated below the time point.

Figure 2

a. Serum NSE level by PCAC in subjects who died. Values are means. Number of subjects at each time point is delineated below the time point. b. Serum NSE level by PCAC in subjects who survived. Values are means. Number of subjects at each time point is delineated below the time point.

Figure 3

Serum S100B level stratified by PCAC. Values are means. (*different from PCAC II and PCAC III, p

Figure 4

a. Serum S100B level by PCAC in subjects who died. Values are means. Number of subjects at each time point is delineated below the time point. b. Serum S100B level by PCAC in subjects who survived. Values are means. Number of subjects at each time point is delineated below the time point.

Figure 4

a. Serum S100B level by PCAC in subjects who died. Values are means. Number of subjects at each time point is delineated below the time point. b. Serum S100B level by PCAC in subjects who survived. Values are means. Number of subjects at each time point is delineated below the time point.