Korean J Crit Care Med.  2014 Nov;29(4):304-312. 10.4266/kjccm.2014.29.4.304.

Prognostic Value and Optimal Sampling Time of S-100B Protein for Outcome Prediction in Cardiac Arrest Patients Treated with Therapeutic Hypothermia

• Kim HS
• Jung HS
• Lim YS
• Woo JH
• Jang JH
• Jang JY
• Yang HJ

• KMID: 2227738
• DOI: http://doi.org/10.4266/kjccm.2014.29.4.304

Abstract

BACKGROUND
The aim of this study was to determine the prognostic value and optimal sampling time of serum S-100B protein for the prediction of poor neurological outcomes in post-cardiac arrest (CA) patients treated with therapeutic hypothermia (TH).
METHODS
We prospectively measured serum S100 calcium binding protein beta subunit (S-100B protein) levels 12 times (0-96 hours) after the return of spontaneous circulation (ROSC). The patients were classified into two groups based on cerebral performance category (CPC): the good neurological outcome group (CPC 1-2 at 6 months) and the poor neurological outcome group (CPC 3-5). We compared serial changes and serum S-100B protein levels at each time point between the two groups and performed receiver operating characteristic curve analysis for the prediction of poor neurological outcomes.
RESULTS
A total of 40 patients were enrolled in the study. S-100B protein levels peaked at ROSC (0 hour), decreased rapidly to 6 hours and maintained a similar level thereafter. Serum S-100B protein levels in the poor CPC group (n = 22) were significantly higher than in the good CPC group (n = 18) at all time points after ROSC except at 4 hours. The time points with highest area under curve were 24 (0.829) and 36 (0.837) hours. The cut-off value, the sensitivity (24/36 hours) and specificity (24/36 hours) for the prediction of poor CPC at 24 and 48 hours were 0.221/0.249 ug/L, 75/65% and 82.4/94.1%, respectively.
CONCLUSIONS
Serum S-100B protein was an early and useful marker for the prediction of poor neurological outcomes in post-CA patients treated with TH and the optimal sampling times were 24 and 36 hours after ROSC.

Keyword

cardiac arrest; hypothermia; S100 calcium binding protein beta subunit

MeSH Terms

Area Under Curve
Heart Arrest*
Humans
Hypothermia*
Prospective Studies
ROC Curve
S100 Calcium Binding Protein beta Subunit*
Sensitivity and Specificity

Figure

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  Fig. 1. Serial changes of S-100B protein level (total patients, n = 40). ROSC: return of spontaneous circulation.

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  Fig. 2. Serial changes of S-100B protein level according to neurological outcomes (Good CPC, n = 18 vs. Poor CPC, n = 22), data were presented by median value with 95% confidence interval. *p < 0.01, †p < 0.05. ROSC: return of spontaneous circulation; CPC: cerebral performance category.

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  Fig. 3. Receiver operating characteristic curve of S-100B protein level at 24 hrs for the prediction of poor cerebral performance category.

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  Fig. 4. Receiver operating characteristic curve of S-100B protein level at 36 hrs for the prediction of poor cerebral performance category.

Reference

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