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J Korean Soc Emerg Med > Volume 17(4); 2006 > Article
Journal of The Korean Society of Emergency Medicine 2006;17(4): 281-290.
Prognosis of Patients with Out-of-Hospital Cardiac Arrest and Early Biochemical Markers: Ischemia Modified Albumin, Procalictonin, and S-100 Protein
Kyung Su Kim, Sang Do Shin, Kyoung Jun Song, Gil Joon Suh, Sue Shin
1Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. shinsangdo@medimail.co.kr
2Department of Laboratory Medicine, Seoul National University Boramae Hospital, Seoul, Korea.
No valuable early marker exists for the prognosis of patients resuscitated from out-of-hospital cardiac arrest (OHCA). We compared post-resuscitation levels of several biochemical candidates and correlated them with outcomes of cardiopulmonary resuscitation (CPR).
Eligible resuscitated patients with OHCA were prospectively enrolled from December 1, 2004 to November 30, 2005. Demographic data were collected and early levels of biochemical candidates were measured both at the time of initiation of CPR and immediately after the return of spontaneous circulation (ROSC), including those of ischemia-modified albumin (IMA), procalcitonin, and S-100 protein. The ROSC over 20 minutes, survival from the emergency room (ER), survival after 1 month, and Glasgow Outcome Scale (GOS) after 1 month were evaluated for outcome. Levels of early biochemical candidates were correlated with those outcomes.
126 patients were eligible for analysis. 81 (64.3%) were male, and the mean age was 59.6+/-17.2 years. The rate of ROSC, survival from ER, and survival after 1 month were 40.5%, 33.3%, and 8.7%, respectively. 4 patients whose GOS was more than 4 showed good neurological outcome. The levels of S-100 protein were significantly lower in the survival group than in the non-survival group after 1 month: 1.6+/-0.8 versus 3.9+/-4.9 microgram/L at the time of initiation of CPR (p<0.01), and 1.6+/-1.1 versus 4.5+/-5.0 microgram/L immediately after ROSC (p=0.01), respectively. IMA and procalcitonin did not show any predictive value. CONCLUSION : The levels of S-100 protein was found to be useful as an early biochemical marker for prognosis following OHCA. S-100 concentrations were significantly lower in the survival group than in the non-survival group after 1 month after successful resuscitation from OHCA.
Key words: Cardiac arrest, Cardiopulmonary resuscitation, Biochemical marker, S 100 protein
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