S-100B protein elevation in patients with the acute coronary syndrome after resuscitation is a predictor of adverse neurological prognosis

Summary

Introduction:
The annual incidence of out-of-hospital cardiac arrest is around 90–190 cases per 100 000 inhabitants. The limi­ting factor for further prognosis of patients after out-of-hospital arrest is their neurological status. The S100B protein is mainly the nervous system cell’s product, it’s glial-specific and mostly expressed by astrocytes. It has been shown that after circulatory arrest its increased level correlates with the prognosis of patients. Work aims to determine the level of protein S100B in the group of patients with acute myocardial infarction without circulatory arrest, and compare it to the value in patients with acute myocardial infarction after out-of-hospital resuscitation.

Methods:
24 patients were evaluated after out-of-hospital resuscitation for the malignant arrhythmias during acute coronary syndrome (ACS). All patients were treated with mild therapeutic hypothermia. The control group consisted of 19 patients with ACS. The sample for the determination of S-100B was taken immediately on admission. Neurological status was evaluated according to the CPC scores (Cerebral Performance Categories) at discharge, patients were divided into 3 groups: CPC1 – good condition, CPC2 – moderate neurological disability, CPC3-5 – serious neurological impairment, coma or death.

Results:
The values of protein S-100B fluctuated, in patients with no resuscitation, in range between 0.038 to 0.204 pg/ml. In patients after resuscitation without subsequent neurological disability (CPC 1) was range 0.077 to 0.817 pg/ml, in patients with moderate to severe neurological disability (CPC 2) was range 0.132–2.59 pg/ml, patients with severe neurological disabilities or deaths had S-100B levels from 0.70 to 8.53 pg/ml. According to ROC analysis we found the cut-off value for the S-100B. Cut-off value for probably a good neurological condition is < 0.23 pg/ml (specificity 
93%, sensitivity 70%), and value testify for supposed severe neurological disability or death is > 1.64 pg/ml (specificity 95%, sensitivity 83%).

Conclusion:
Protein S-100B is one of the early and sensitive markers of severe brain damage in patients after cardiac arrest. Its early determination can help in prediction of patient neurological condition and help doctors to decide further action.

Key words:
S-100B – acute coronary syndrom – cardiac arrest