Outcome after cardiac arrest:: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale

Background and purpose: Patients resuscitated from cardiac arrest are at risk of subsequent death or poor neurological outcome up to a persistent vegetative state. We investigated the prognostic value of several epidemiological and clinical markers and two neuroproteins, neuron-specific enolase (NSE) and S-100 protein (S-100), in 97 patients undergoing cardiopulmonary resuscitation (CPR) after non-traumatic cardiac arrest between 1998 and 2002. Results: 52.6% of the patients died, 28.8% survived with severe, moderate or without neurological disorders, and 18.6% remained in a persistent vegetative state. Unconsciousness > 48 h after CPR predicted a 60.6-fold (95% Cl 14.3287-257.205, p = 0.001) and a Glasgow Coma Scale (GCS) < 6 points after 72 h a 11.2-fold (CI 95%, 3.55-36.44, p < 0.001) risk of poor neurological outcome. Serum levels > 65 ng/ml for NSE and > 1.5 mu g/l for S-100 increased the risk of death and persistent vegetative state 16.8 (95% Cl 2.146-131.520)- and 12.6 (95% Cl 1.1093-99.210)- fold, respectively. By combination of the GCS with elevated serum concentrations of both neuroproteins above the cut off levels on third day after CPR a poor neurological outcome was predicted with a specificity of 100%. Conclusion: The combination of GCS with the serum levels of both neuroproteins at 72 It after CPR permit a more reliable prediction of outcome in post arrest coma than the single markers alone, independent of the application of anaesthetic agents. (c) 2004 Elsevier Ireland Ltd. All rights reserved.