S-100B and neuron-specific enolase as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation: a systematic review

Abstract

IntroductionNeurological prognostic factors after cardiopulmonary resuscitation (CPR) in patients with cardiac arrest (CA) as early and accurately as possible are urgently needed to determine therapeutic strategies after successful CPR. In particular, serum levels of protein neuron-specific enolase (NSE) and S-100B are considered promising candidates for neurological predictors, and many investigations on the clinical usefulness of these markers have been published. However, the design adopted varied from study to study, making a systematic literature review extremely difficult. The present review focuses on the following three respects for the study design: definitions of outcome, value of specificity and time points of blood sampling.MethodsA Medline search of literature published before August 2008 was performed using the following search terms: "NSE vs CA or CPR", "S100 vs CA or CPR". Publications examining the clinical usefulness of NSE or S-100B as a prognostic predictor in two outcome groups were reviewed. All publications met with inclusion criteria were classified into three groups with respect to the definitions of outcome; "dead or alive", "regained consciousness or remained comatose", and "return to independent daily life or not". The significance of differences between two outcome groups, cutoff values and predictive accuracy on each time points of blood sampling were investigated.ResultsA total of 54 papers were retrieved by the initial text search, and 24 were finally selected. In the three classified groups, most of the studies showed the significance of differences and concluded these biomarkers were useful for neurological predictor. However, in view of blood sampling points, the significance was not always detected. Nevertheless, only five studies involved uniform application of a blood sampling schedule with sampling intervals specified based on a set starting point. Specificity was not always set to 100%, therefore it is difficult to indiscriminately assess the cut-off values and its predictive accuracy of these biomarkers in this meta analysis.ConclusionsIn such circumstances, the findings of the present study should aid future investigators in examining the clinical usefulness of these markers and determination of cut-off values.

Determination of the phosphorylated neurofilament subunit NF-H (pNF-H) in cerebro-spinal fluid as biomarker in acute traumatic spinal cord injuries / Dozarea neurofilamentelor fosforilate (subunitatea pNF-H) ȋn LCR ca biomarker ȋn traumatismul vertebro-medular acut

“…These are biomarkers whose presence is indicative of lesion and they evaluate the pathologic processes during the spinal cord injury. (15)(16)(17). Several studies have analyzed more biomarkers for the nervous tissue injury (c-Tau, myelin basic protein -MBP, neuron-specific enolase -NSE, glial fibrillar acidic protein -GFAP etc.…”

Persistently elevated extracellular HSP70 (HSPA1A) level as an independent prognostic marker in post-cardiac-arrest patients

“…Moreover, they might prove even more straightforward in everyday clinical practice than neuroimaging or electrophysiological testing (Shinozaki et al 2009). In the present study, we have analyzed for the first time HSP70 as a predictor of all-cause mortality in comatose, resuscitated patients, who have undergone hypothermia treatment.…”

“…Ischemia and reperfusion injury cause intense stress in the brain by multiple pathways, including oxidative stress, microvascular injury, excitotoxicity, blood-brain barrier dysfunction, postischemic inflammation initiated by neuronal, glial and endothelial cell death, or apoptosis. Reliable biomarkers of brain ischemia and of reperfusion injury are the S100 protein B (S100B), and the neuronspecific enolase (NSE); a strong correlation exists between these markers and in the prognosis of post-cardiac-arrest patients (Shinozaki et al 2009). Recently, Hecker et al reviewed the potential of HSP70 as a biomarker for the rapid detection of brain and spinal cord ischemia (Hecker and McGarvey 2011).…”

TD-12 workshop report: characterization of monoclonal antibodies to neuron-specific enolase

“…Increased levels of NSE have also been identified in patients after brain damage [11] and in individuals who have suffered a recent myocardial infarction or cerebral accident [12][13][14]. The marker has been shown to have prognostic value in cerebrovascular accident victims [15].…”