Serum Biomarkers of Brain Injury to Classify Outcome After Pediatric Cardiac Arrest*

Abstract

Objective Morbidity and mortality in children with cardiac arrest (CA) largely result from neurologic injury. Serum biomarkers of brain injury can potentially measure injury to neurons (neuron specific enolase [NSE]), astrocytes (S100b), and axons (myelin basic protein [MBP]). We hypothesized that serum biomarkers can be used to predict outcome from pediatric CA. Design Prospective observational study. Setting Single tertiary pediatric hospital. Patients Forty-three children with cardiac arrest. Interventions None. Measurements and Main Results We measured serum NSE, S100b, and MBP on days 1–4 and 7 after CA. We recorded demographics, details of the CA and resuscitation, and Pediatric Cerebral Performance Category (PCPC) at hospital discharge and 6 months. We analyzed the association of biomarker levels at 24, 48, and 72 hours with good (PCPC 1–3) or poor (PCPC 4–6) outcome and mortality. Forty-three children (49% female; mean age of 5.9 ± 6.3 were enrolled and 17 (40%) died. Serum concentration at 24 hours for all 3 biomarkers predicted mortality (all p<0.05). Additionally, serum NSE and S100b concentrations were increased in the poor outcome vs. good outcome group and in subjects who died at all time points (all p<0.05). Receiver operator curves for serum S100b and NSE to predict good vs. poor outcome at 6 months was superior to clinical predictors. There was no association between serum biomarker concentrations and subject temperature. Conclusions Preliminary data show that serum S100b, NSE, and MBP may aid in outcome prediction of children surviving CA.

Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

“…For the important outcomes of survival to hospital discharge and hospital discharge with good neurologic outcome, we identified very-low-quality evidence for prognostic significance (downgraded for risk of bias and imprecision) from 2 pediatric observational studies of IHCA and OHCA, 102,104 enrolling a total of 78 children showing that lower neuron-specific enolase (NSE) or S100B serum levels at 24, 48, and 72 hours are associated with an increased likelihood of improved outcomes (P<0.001 to P<0.02).…”

Neuromarkeriai

“…MBP padeda išlaikyti tinkamą mielino struktūrą ir sąveikauja su mielino membranos lipidais. Tai -aksonų pažeidimo žymuo (26,33). Šis baltymas nustatomas kraujo serume (ELISA metodu) ir likvore (25,29).…”

Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

“…For the critical outcome of survival to 180 days with good neurologic outcome, we identified very-low-quality evidence for prognostic significance (downgraded for imprecision and risk of bias) from 1 pediatric observational prospective cohort study of IHCA and OHCA, 102 enrolling 43 children showing that reactive pupils at 24 hours after ROSC is associated with improved outcomes (RR, 5.94; 95% CI, 1.5-22.8).…”