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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 : Background. 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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