Article Text

PDF
Heart rhythm disorders and pacemakers
Prediction of cognitive dysfunction after resuscitation from out-of-hospital cardiac arrest using serum neuron-specific enolase and protein S-100
  1. Neil R Grubb1,
  2. Catriona Simpson2,
  3. Roy A Sherwood3,
  4. Hagosa D Abraha3,
  5. Stuart M Cobbe4,
  6. Ronan E O’Carroll5,
  7. Ian Deary6,
  8. Keith A A Fox2
  1. 1
    Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2
    University of Edinburgh Cardiovascular Research Unit, UK
  3. 3
    Kings College Hospital, London, UK
  4. 4
    Department of Medical Cardiology, Glasgow Royal Infirmary, UK
  5. 5
    University of Stirling, UK
  6. 6
    University of Edinburgh, UK
  1. Dr N R Grubb, Department of Cardiology, Royal Infirmary of Edinburgh, 31 Little France Crescent, Edinburgh EH16 4SA, UK; neil.grubb{at}btopenworld.com

Abstract

Background: More than 50% of patients initially resuscitated from out-of-hospital cardiac arrest die in hospital.

Objective: To investigate the prognostic value of serum protein S-100 and neuron-specific enolase (NSE) concentrations for predicting (a) memory impairment at discharge; (b) in-hospital death, after resuscitation from out-of-hospital cardiac arrest.

Methods: In a prospective study of 143 consecutive survivors of out-of-hospital cardiac arrest, serum samples were obtained within 12, 24–48 and 72–96 hours after the event. S-100 and NSE concentrations were measured. Pre-discharge cognitive assessment of patients (n = 49) was obtained by the Rivermead Behavioural Memory Test (RBMT). The relationship between biochemical brain marker concentrations and RBMT scores, and between marker concentrations and the risk of in-hospital death was examined.

Results: A moderate negative relationship was found between S-100 concentration and memory test score, at all time points. The relationship between NSE and memory test scores was weaker. An S-100 concentration >0.29 μg/l at time B predicted moderate to severe memory impairment with absolute specificity (42.8% sensitivity). S-100 remained an independent predictor of memory function after adjustment for clinical variables and cardiac arrest timing indices. NSE and S-100 concentrations were greater in patients who died than in those who survived, at all time points. Both NSE and S-100 remained predictors of in-hospital death after adjustment for clinical variables and cardiac arrest timing indices. The threshold concentrations yielding 100% specificity for in-hospital death were S-100: 1.20 μg/l (sensitivity 44.8%); NSE 71.0 μg/l (sensitivity 14.0%).

Conclusions: Estimation of serum S-100 concentration after out-of-hospital cardiac arrest can be used to identify patients at risk of significant cognitive impairment at discharge. Serum S-100 and NSE concentrations measured 24–48 hours after cardiac arrest provide useful additional information.

  • cardiac arrest
  • hypoxia–ischaemia (brain)
  • cognitive function

Statistics from Altmetric.com

Footnotes

  • Competing interests: Dr NR Grubb was reimbursed for consultancy work for St Jude Medical between 2005 and 2006. He was also reimbursed for consultancy work for CardioDigital, a signal analysis company, between 2003 and 2006. Dr Grubb does not hold shares in either company.

  • Abbreviations:
    CPR
    cardiopulmonary resuscitation
    CV
    coefficient of variation
    GCS
    Glasgow Coma Score
    NART
    National Adult Reading Test
    NSE
    neurone-specific enolase
    RBMT
    Rivermead Behavioural Memory Test
    ROC
    receiver operating characteristic

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.