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Master Thesis

Rôle de la Protéine S-100B pour l’évaluation précoce du pronostic neurologique dans la phase aiguë après arrêt cardiaque

Abstract : Early and reliable prognostication after cardiac arrest (CA) is crucial. Objectives: we hypothesized that protein S100B (PS100B) could more accurately predict outcome in the early phase of CA compared with current biomarkers. Methods: this prospective single-center study included 351 consecutive adult comatose non-traumatic and successfully resuscitated CA patients, treated with targeted temperature management but not Extra-Corporeal Life Support. Biomarkers were sampled as soon as possible after return of spontaneous circulation. Results: favorable outcome (Cerebral performance category: CPC 1-2) was observed in 36% and 33% at hospital discharge and 3-month follow-up respectively. At Day 0, all biomarkers were significantly associated with favorable outcome at hospital discharge and 3 months (P≤0.001). PS100B-D0 was able to discriminate CPC 1 versus CPC 2 at discharge and 3 months and was able to discriminate CPC1-2-3 versus CPC 5. An increasing PS100B value between D0 and D1 was associated with poor outcome at hospital discharge and 3-months (P=0.0001 and P=0.001, respectively). At D0, best AUC for ROC curves regarding outcome at discharge was for PS100B (AUC: 0.80 [95%-CI: 0.75-0.86]), compared with other biomarkers (p<0.0001). A PS100B at D0 threshold of 3.78 μg/L could classify 15% of patients as with unfavorable outcome at discharge and 3 months respectively (99%-specificity, 95%-CI: [94-99], 1 false positive) and 98%-positive predictive value. No-flow, PS100B at D0, lactate at D0, clinical seizures, and initial non-shockable rhythm were independent predictors associated with unfavorable outcome at discharge in multivariate analysis. Conclusions: early PS100B values compared with other biomarkers were highly correlated with outcome at mid and long-term follow-up.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02494396
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Philippe Nguyen. Rôle de la Protéine S-100B pour l’évaluation précoce du pronostic neurologique dans la phase aiguë après arrêt cardiaque. Médecine humaine et pathologie. 2018. ⟨dumas-02494396⟩

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