4.6 Article

Serum S100 Protein Is a Reliable Predictor of Brain Injury After Out-of-Hospital Cardiac Arrest: A Cohort Study

Journal

FRONTIERS IN CARDIOVASCULAR MEDICINE
Volume 8, Issue -, Pages -

Publisher

FRONTIERS MEDIA SA
DOI: 10.3389/fcvm.2021.624825

Keywords

brain injury; cardiac arrest; hypothermia; neuroprognostication; prehospital resuscitation; acute cardiac care

Funding

  1. Research Grant of the Ministry of Health, Czech Republic-Conceptual development of research organization (Institute for Clinical and Experimental MedicineIKEM) [IN 00023001]
  2. endowment fund Heart

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The study evaluated the role of serum S100 protein in early neuroprognostication of comatose survivors of out-of-hospital cardiac arrest. Results showed that increased S100 levels at 48 hours after the event were independently associated with unfavorable neurological outcomes at 30 days. A 48-hour S100 value >= 0.37 μg/L had high specificity (100%) and moderate sensitivity (39%) in predicting an unfavorable neurological outcome within 30 days.
Purpose: To evaluate serum S100 protein at hospital admission and after 48 h in early neuroprognostication of comatose survivors of out-of-hospital cardiac arrest (OHCA). Methods: The study included 48 consecutive patients after OHCA, who survived for at least 72 h after the event. The patients were divided based on their best cerebral performance category (CPC) achieved over a 30 day follow-up period: favorable neurological outcome (CPC 1-2) vs. unfavorable neurological outcome (CPC 3-4). Predictors of an unfavorable neurological outcome were identified by multivariable regression analysis. Analysis of the receiver operating characteristic curve (ROC) was used to determine the cut-off value for S100, having a 0% false-positive prediction rate. Results: Of the 48 patients, 30 (63%) had a favorable and 18 (38%) had an unfavorable neurological outcome. Eleven patients (23%) died over the 30 day follow-up. Increased S100 levels at 48 h after OHCA, but not the baseline S100 levels, were independently associated with unfavorable neurological outcome, with an area under the ROC curve of 0.85 (confidence interval 0.74-0.96). A 48 h S100 value >= 0.37 mu g/L had a specificity of 100% and sensitivity of 39% in predicting an unfavorable 30 day neurological outcome. Conclusion: This study showed that S100 values assessed 48 h after an OHCA could independently predict an unfavorable neurological outcome at 30 days.

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