Neurobehavioral Outcome Prediction After Cardiac Surgery

Abstract

Background and Purpose-The goal of the present study was to investigate the predictive value of neurobiochemical markers of brain damage (protein S-100B and neuron-specific enolase [NSE]) with respect to the short-and long-term neuropsychological outcomes after cardiac surgery with cardiopulmonary bypass (CPB). Methods-We investigated 74 patients who underwent elective CABG or valve replacement surgery and who showed no severe neurological deficits after surgery. Patients were investigated with a standardized neurological examination and a comprehensive neuropsychological and neuropsychiatric assessment 1 to 2 days before surgery, 3 and 8 days after surgery, and 6 months later. Serial venous blood samples were taken preoperatively and 1, 6, 20, and 30 hours after skin closure. Protein S-100B and NSE were analyzed with immunoluminometric assays. Results-Patients with severe postoperative neuropsychological disorders showed a significantly higher and longer release of neurobiochemical markers of brain damage. Patients who presented with a delirium according to DSM-III-R criteria 3 days after surgery had significantly higher postoperative S-100B serum concentrations. Multivariate analysis (based on postoperative NSE and S-100B concentrations and age of patients, type of operation, length of cross-clamp and perfusion time, and intraoperative and postoperative oxygenation) identified NSE and S-100B concentrations 6 to 30 hours after skin closure as the only variables that contributed significantly to a predictive model of the neuropsychological outcome. NSE, but not S-100B, release was significantly higher in patients undergoing valve replacement surgery. Conclusions-Postoperative serum concentrations and kinetics of S-100B and NSE have a high predictive value with respect to the early neuropsychological and neuropsychiatric outcome after cardiac surgery. The analysis of NSE and S-100B release might allow insight into the underlying pathophysiology of brain dysfunction, thus providing a valuable tool to monitor and evaluate measures to improve cardiac surgery with CPB. (Stroke. 2000;31:645-650.)

Astroglial Protein S-100 Is an Early and Sensitive Marker of Hypoxic Brain Damage and Outcome After Cardiac Arrest in Humans

“…Therefore, a marker for astroglial cell damage may indirectly reflect neuronal damage. [17][18][19] Because of the estimated biological half-life of Ϸ2 hours, 23 constantly elevated levels of S-100 in patients with documented brain damage, as observed in the present study, may reflect a continuous release from damaged tissue. At 48 hours after cardiac arrest, all patients with S-100 levels of Ͼ1.1 g/L were subsequently diagnosed in the present study as having brain damage.…”

“…[13][14][15][16] Recently, S-100 has been found to be a promising marker for central nervous system injury. [17][18][19][20][21][22][23][24] Protein S-100 is part of a large family of calcium-binding proteins, and evidence exists that S-100 regulates calciumdependent cellular signaling in neuronal differentiation, outgrowth, and apoptosis through different concentrations. [25][26][27][28][29] Elevated serum levels of S-100 have been documented in patients suffering from different types of brain damage, including stroke, minor and severe head injury, and brain damage associated with extracorporeal circulation and later stages of global cerebral ischemia.…”

“…[25][26][27][28][29] Elevated serum levels of S-100 have been documented in patients suffering from different types of brain damage, including stroke, minor and severe head injury, and brain damage associated with extracorporeal circulation and later stages of global cerebral ischemia. [17][18][19][20][21][22][23][24] No data are available, however, concerning serum levels of S-100 during the early phase after global cerebral ischemia from cardiocirculatory arrest in humans. In an attempt to find an early marker of hypoxic brain damage and outcome, we investigated the serum levels of astroglial protein S-100 during CPR and after restoration of spontaneous circulation (ROSC).…”

Pathophysiology of Delirium in the Intensive Care Unit

“…Markers such as neuron-specific enolase, S-100 beta, and neuronal tau protein have been used for this purpose and may provide clues regarding the onset of brain injury in delirium. In particular, S-100 beta could be promising because it has been linked to postoperative cognitive dysfunction [90]; however, other attempts to examine surrogates of neuronal cell death have been inconsistent at best [91,92].…”

Biomarkers of cerebral injury in cardiac surgery

“…Serum NSE may increase during and after cardiac surgery (43). Serum NSE significantly elevated at 6-30 hours after skin closure in patients undergoing valve replacement surgery (44); while it peaked at 72 hours following coronary artery bypass (31). The elevation of serum NSE may persist until 6 months after cardiac surgery in relation to neuropsychological impairment of the patients (43).…”