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J Korean Soc Emerg Med > Volume 19(6); 2008 > Article
Journal of The Korean Society of Emergency Medicine 2008;19(6): 657-664.
Early Detection and Prognosis Prediction of Severe sepsis and Septic shock in Emergency Triage Room
Sung Hoon Beak, Kyoung Mi Lee, Dae Young Hong, Seung Baik Han, Kang Ho Kim, Jun Sig Kim, Ji Yoon Kim, Ji Hye Kim, Hwan Cheol Kim
1Department of Emergency Medicine, Gachon University, Gil Medical center, Incheon, Korea. yongem@gilhospital.com
2Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Masan Samsung Hospital, Masan, Korea.
Biochemical markers can help predict neurological outcome in post-resuscitation patients. This prospective study evaluated the prognostic value of serum S100B protein and neuron-specific enolase (NSE) time courses in predicting unfavorable neurological outcomes.
We serially measured serum S100B protein and NSE levels 12 times during the 96 h after the return of spontaneous circulation (ROSC) in 40 patients. Neurological outcome was assessed at 6 months after cardiac arrest. Patients were divided into good (CPC 1 to 2) and poor (CPC 3 to 5) neurological outcome groups and assessed for cerebral performance category scores. We compared the two groups at each serum value and calculated cut-off values.
Serum S100B protein levels over the study period, except at 4 hours, and NSE levels from 14 hours after ROSC were significantly higher in the poor neurological outcome group (n=32) than the good neurological outcome group (n=8). The most predictive serum S100B protein and NSE times were at 14 hours (cut off value=0.16 microgram/L, sensitivity 81.8%, specificity 100%, AUC=0.938) and 54 hours (cut off value=19.21 microgram/L, sensitivity 86.4%, specificity 100%, AUC=0.932).
Serum S100B protein and NSE levels are early and useful markers for assessing neurological outcome after successful resuscitation from cardiac arrest.
Key words: S100B protein, Phosphopyruvate Hydratase, Heart arrest, Prognosis
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