Usefulness of early plasma S-100B protein and Neuron-Specific Enolase measurements to identify cerebrovascular etiology of out-of-hospital cardiac arrest

Nicolas Mongardon; Michel Arnaout; Guillaume Geri; Camille Chenevier-Gobeaux; Nicolas Deye; Stéphane Legriel; Fabrice Daviaud; Sybille Merceron; Nathalie Marin; Frédéric Pène; Jean-Paul Mira; Alain Cariou

doi:10.1016/j.resuscitation.2018.07.004

Usefulness of early plasma S-100B protein and Neuron-Specific Enolase measurements to identify cerebrovascular etiology of out-of-hospital cardiac arrest

Resuscitation. 2018 Sep:130:61-66. doi: 10.1016/j.resuscitation.2018.07.004. Epub 2018 Jul 5.

Affiliations

¹ Medical Intensive Care Unit, Cochin University Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 15 rue de l'Ecole de Médecine, 75006 Paris, France. Electronic address: nicolas.mongardon@aphp.fr.
² Medical Intensive Care Unit, Cochin University Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 15 rue de l'Ecole de Médecine, 75006 Paris, France.
³ Medical Intensive Care Unit, Cochin University Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 15 rue de l'Ecole de Médecine, 75006 Paris, France; Paris Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 56 rue Leblanc, 75015 Paris, France.
⁴ Service de Diagnostic Biochimique Automatisé (SDBA), Cochin University Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France.
⁵ Medical Intensive Care Unit, Lariboisière University Hospital, Groupe Hospitalier Lariboisière Saint-Louis, Assistance Publique des Hôpitaux de Paris, Unité Inserm U942 - Paris Diderot, 75010 Paris, France; Paris Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 56 rue Leblanc, 75015 Paris, France.
⁶ Intensive Care Unit, Versailles Hospital Center, 177 rue de Versailles, 78150 Le Chesnay, France; Paris Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 56 rue Leblanc, 75015 Paris, France.
⁷ Intensive Care Unit, Versailles Hospital Center, 177 rue de Versailles, 78150 Le Chesnay, France.
⁸ Medical Intensive Care Unit, Cochin University Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France.

PMID: 29981819
DOI: 10.1016/j.resuscitation.2018.07.004

Abstract

Background: While S-100B protein and Neuron-Specific Enolase (NSE) dosages have been extensively investigated for neurological prognostication after cardiac arrest (CA), there is no data about their ability to detect a cerebrovascular cause of CA. We assessed the utility of plasma S-100B protein and NSE measurements for early diagnosis of primary neurological cause in resuscitated CA patients.

Patients and methods: Case control study based on two prospectively acquired CA databases. Patients with a primary cerebrovascular etiology were compared with randomly selected CA of non-neurological cause. S-100B protein and NSE were measured at ICU admission in all patients.

Results: CA was due to a cerebrovascular etiology in 18 patients (subarachnoid hemorrhage, n = 15; ischemic stroke, n = 3), with an ICU mortality of 100%. Comparative group was constituted with 66 patients (cardiac etiology n = 45, respiratory etiology n = 21), with an ICU mortality of 71%. Admission S-100B protein concentration was 2.0 [0.63-7.15] μg/L in the cerebrovascular group and 0.45 [0.24-1.95] in the non-cerebrovascular group (p < 0.001). In contrast, NSE concentration was similar in cerebrovascular and non-cerebrovascular etiologies (35 [25-103] μg/L vs. 27 [19-47] respectively, p = 0.16). Area under ROC curves for S-100B protein and NSE to predict cerebrovascular cause of CA was 0.75 [95% CI: 0.64-0.87] and 0.61 [95% CI: 0.45-0.76], respectively.

Conclusions: Even if S-100B protein dosage performs slightly better than NSE, early dosages of these biomarkers are poorly predictive of a cerebrovascular etiology of CA. Our results suggest that early measurement of brain biomarkers should not be recommended to tailor the imaging strategy employed to investigate the CA cause.

Keywords: Biomarker; Cardiac arrest; Etiology; Neuron-Specific Enolase; Outcome; S-100B protein; Stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Biomarkers / blood
Case-Control Studies
Early Diagnosis
Female
France / epidemiology
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest* / etiology
Out-of-Hospital Cardiac Arrest* / mortality
Out-of-Hospital Cardiac Arrest* / therapy
Phosphopyruvate Hydratase / blood*
Predictive Value of Tests
Prognosis
ROC Curve
S100 Calcium Binding Protein beta Subunit / blood*
Stroke* / blood
Stroke* / complications
Stroke* / diagnosis

Substances

Biomarkers
S100 Calcium Binding Protein beta Subunit
Phosphopyruvate Hydratase