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SERUM S100 beta AS A PREDICTOR OF NEUROLOGIC AND NEUROCOGNITIVE OUTCOMES AFTER CARDIAC SURGERY

Grocott, HP MD, FRCPC; Croughwell, ND CRNA; Verkerk, GC BA; Amory, DW MD, PhD; White, WD MPH; Kirchner, J BS; Newman, MF MD

doi: 10.1097/00000539-199802001-00065
Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Cardiovascular Anesthesia
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Department of Anesthesiology, Duke Heart Center, Duke University Medical Center, Durham, NC, 27710.

Abstract S65

Introduction: The glial protein, S100 beta, has been reported to be a marker of neurologic injury in numerous clinical settings [1]. Recently, reports have described serum S100 beta elevations after cardiac surgery, suggesting its potential role as a marker for cardiac surgery-associated neurologic injury [2]. The purpose of this study was to examine the relationship between serum S100 beta and neurologic and neurocognitive outcomes after coronary artery bypass graft surgery (CABG).

Methods: Under midazolam/fentanyl anesthesia, 135 patients having CABG employing CPB (non-pulsatile, alpha-stat pH, membrane oxygenator, arterial line filter, temp 32-36 [degree sign]C) were studied. Serum S100 beta was measured pre-CPB, end-CPB, then 150 and 270 min after cross-clamp release, with the maximal S100 beta level used for analysis. A battery of cognitive tests was performed preoperatively and 6 weeks postoperatively with neurologic testing performed preop and at discharge. A neurocognitive deficit was determined by the cognitive impairment index (CI index), calculated as the average % decline in each of the cognitive tests. Neurologic testing was evaluated as a change in the Western perioperative neurologic score (WPNS Delta). The maximum S100 beta was compared to the outcomes using linear regression (univariate. then multivariable, adjusting for age).

Results: S100 beta showed a significant univariate association with neurocognitive and neurologic outcomes. The multivariable model (accounting for age) remained significant for neurologic outcome, but less significant for the neurocognitive outcome. (Table 1 and Figure 1)

Table 1

Table 1

Figure 1

Figure 1

Discussion: This is the first study examining the S100 beta association to neurocognitive and neurologic outcomes that is large enough to control for possible confounding variables, such as age [3].

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REFERENCES

1. Persson L, et al. Stroke 18: 911-18, 1987
2. Westaby S, et al. Ann Thorac Surg 61: 88-92, 1996
3. Sheng JG, et al. Neurobiol Aging 17:359-63, 1996
© 1998 International Anesthesia Research Society