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J Thorac Cardiovasc Surg 2000;119:138-147
© 2000 Mosby, Inc.
CARDIOPULMONARY SUPPORT AND PHYSIOLOGY |
From the University Departments of Neurology,a Cardio-Thoracic Surgery,d and Medical Statistics and Epidemiology,b Halle/Saale, and of Clinical Chemistry and Laboratory Diagnostics,c Jena, Germany.
Address for reprints: D. Georgiadis, MD, Department of Neurology, Martin-Luther-University at Halle-Wittenberg, Ernst Grube Str 40, 06097 Halle/Saale, Germany (E-mail: dimitrios.georgiadis{at}medizin.uni-halle.de).
Objectives: The aim of this study was to evaluate the time course of S-100ß and neuron-specific enolase serum levels after cardiac surgery and their clinical relevance in predicting postoperative adverse neurologic outcomes; the 2 proteins are only released in peripheral blood in association with nervous system lesions.
Methods: We neurologically assessed 190 consecutive patients undergoing elective cardiac operations for coronary artery bypass (n = 147), valve replacement (n = 29), or both (n = 14), before as well as after the operation. Postoperative outcome was classified as type I (uncomplicated), type II (confusion, agitation, disorientation, or epileptic seizures), or type III (stroke, stupor, or coma). Levels of S-100ß and neuron-specific enolase were evaluated in venous blood samples drawn preoperatively and then daily in the first 5 postoperative days.
Results: Levels of S-100ß and neuron-specific enolase differed significantly among the 3 groups (type III > type II > type I) throughout the postoperative period and had a diagnostic specificity and specificity of 89% and 79%, respectively, in identifying patients with type III outcome. S-100ß (but not neuron-specific enolase) levels were identified as significant independent predictors for type II and III outcomes (odds ratio 16.2, P < .0004). The same was true for duration of cardiopulmonary bypass (odds ratio 1.02, P < .006).
Conclusions: Serum levels of S-100ß are reliable markers for adverse neurologic outcomes after cardiac surgery.
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