ABSTRACT
This prospective study evaluated the prognostic value of early neurobiochemical markers, neuron-specific enolase and astroglial protein S-100B, for long-term cognitive outcome after cardiac arrest. Six months after admission of a cohort of 80 consecutive patients, 26 survivors were able to undergo a neuropsychological test battery. Survivors showed low test performances in attention, learning/memory, and executive functioning. Neuropsychological bedside screening during the first month significantly differentiated between patients with and without long-term cognitive impairment. The neurobiochemical marker S-100B at day 3 after admission was found to predict significant proportions of variance in specific cognitive domains (learning/memory and executive functioning). The results indicate that early neuropsychological assessment might help identify patients who run at risk of long-term neuropsychological dysfunction. This study also suggests that especially the protein S-100B provides valuable information on long-term cognitive outcomes. To understand the exact relationship, results have to be replicated in larger trials.
Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/etiology , Heart Arrest/complications , Adult , Aged , Analysis of Variance , Attention/physiology , Cognition Disorders/metabolism , Cohort Studies , Female , Heart Arrest/metabolism , Humans , Learning/physiology , Male , Mental Status Schedule , Middle Aged , Motor Skills/physiology , Nerve Growth Factors/blood , Neuropsychological Tests , Phosphopyruvate Hydratase/blood , Predictive Value of Tests , Problem Solving/physiology , ROC Curve , Regression Analysis , Retrospective Studies , S100 Calcium Binding Protein beta Subunit , S100 Proteins/blood , Time Factors , Visual Perception/physiologyABSTRACT
OBJECTIVE: To determine the prognostic accuracy of biochemical, clinical, electrophysiological, and neuropsychological investigations in predicting outcomes after cardiac arrest. DESIGN: Prospective study. SETTING: Intensive care unit of the Hamburg-Eppendorf University Medical Center, Hamburg, Germany. PATIENTS: A total of 80 patients (mean age, 63.79 +/- 15.85 yrs) after cardiopulmonary resuscitation. INTERVENTIONS: Serial blood samples (days 2-4), clinical examinations (days 2 and 4), sensory-evoked potentials (day 4), and neuropsychological assessments (Subject(s)
Cardiopulmonary Resuscitation
, Evoked Potentials, Somatosensory
, Heart Arrest/therapy
, Nerve Growth Factors/blood
, Neuropsychological Tests
, Phosphopyruvate Hydratase/blood
, S100 Proteins/blood
, Adolescent
, Adult
, Aged
, Aged, 80 and over
, Biomarkers/blood
, Coma
, Female
, Heart Arrest/blood
, Heart Arrest/physiopathology
, Humans
, Logistic Models
, Male
, Middle Aged
, Multivariate Analysis
, Prognosis
, Proportional Hazards Models
, Prospective Studies
, ROC Curve
, S100 Calcium Binding Protein beta Subunit
, Sensitivity and Specificity
, Treatment Outcome