Time course of neurone-specific enolase and S-100 protein release during and after coronary artery bypass grafting

Abstract

Serum neurone-specific enolase (NSE) and S-100 protein are well established as markers of cerebral injury, and have been used as markers of neuronal and glial cell damage, respectively, after cardiac surgery with cardiopulmonary bypass (CPB), but the speed of their increase during CPB has not been studied. Therefore, we have investigated the time course of NSE and S-100 release during and after CPB. We studied 18 adult patients undergoing elective coronary artery bypass grafting (CABG). Standard hypothermic (32 degrees C) pulsatile bypass with membrane oxygenation was used. Blood samples were obtained at induction, before bypass, before rewarming, at the end of rewarming, 10 min, 1 h and 8 h after bypass and 1, 2 and 3 days after surgery. NSE and S-100 were assayed using immunoradiometric assay kits (Sangtec Medical). NSE and S-100 release followed similar time courses. Both increased sharply during bypass, reached peak concentrations at the end of rewarming (mean 25.55 (SEM 2.79) and 1.65 (0.23) microgram litre-1, respectively), had decreased significantly by the end of operation and returned to pre-bypass concentrations by the second day after surgery. No patient developed a major neurological deficit. When using NSE and S-100 assays to study cerebral dysfunction in relation to CPB, postoperative samples miss peak (end-bypass) concentrations, and studies should be designed to include intraoperative samples.

The neuroinflammatory hypothesis of delirium

“…Thus, several conditions associated with acute systemic inflammation (e.g. septic shock and cardiac surgery) are presumably associated with BBB dysfunction [2,48,99]. Likewise, BBB disruption during episodes of delirium can be inferred from a recent study showing elevated serum levels of protein S100-b in acutely ill elderly medical patients with delirium [139].…”

Factors Affecting the Postoperative Outcome in Adult Cardiac Surgery with Cardiopulmonary Bypass

“…Platelet counts were lower than baseline on CPB-10m and CPB-off (p=0.013 and p=0.04, respectively, Table 3). These findings indicate that CPB system causes inflammatory reactions and platelet activation and aggregation due to the oxygenator and sucker pump [1][2][3][4]. D-dimer level at CPB-off (p=0.04) was significantly higher than that of Pre-CPB (Table 3).…”

Neurocognitive dysfunction after cardiac surgery and biochemical markers

“…[37] Glikolitik yolda 2-fosfo-D-gliseratın fosfoenolpirüvata dönüşümünü katalizleyen dimerik enzimdir. [10] Yarılanma ömrü 24 saat olan NSE'nin molekül ağırlığı 78 kDa'dır.…”

“…[37] nörofizyometrik hasar ile biyobelirteçler arasındaki ilişkiyi incelemeksizin yaptıkları araştırmada, elektif KABG cerrahisi geçiren hastaların perioperatif S100b ve NSE değerlerinin seyrini analiz etmişlerdir. Sonuçta her iki biyobelirteç, yeniden ısınmadan önce anlamlı olarak artmış ve yeniden ısınmanın sonunda en üst düzeylere ulaşmıştır.…”

“…Ancak her iki araştırma da S100b ve NSE düzeylerindeki azalmanın (S100b'da ani azalma, NSE'de kademeli azalma) benzer olduğu sonucunda birleşmektedir. [37,50] S100b ve NSE'nin karşılaştırıldığı araştırmada, Rasmussen ve ark. [57] kalp dışı cerrahide ameliyat sonrası kognitif fonksiyon bozukluğu ile bu iki biyobelirteç arasında ilişki olmadığını göstermişlerdir.…”