Controversial significance of early S100B levels after cardiac surgery

BACKGROUND: The brain-derived protein S100B has been shown to be a useful marker of brain injury of different etiologies. Cognitive dysfunction after cardiac surgery using cardiopulmonary bypass has been reported to occur in up to 70% of patients. In this study we tried to evaluate S100B as a marker for cognitive dysfunction after coronary bypass surgery with cardiopulmonary bypass in a model where the inflow of S100B from shed mediastinal blood was corrected for. METHODS: 56 patients scheduled for coronary artery bypass grafting underwent prospective neuropsychological testing. The test scores were standardized and an impairment index was constructed. S100B was sampled at the end of surgery, hourly for the first 6 hours, and then 8, 10, 15, 24 and 48 hours after surgery. None of the patients received autotransfusion. RESULTS: In simple linear analysis, no significant relation was found between S100B levels and neuropsychological outcome. In a backwards stepwise regression analysis the three variables, S100B levels at the end of cardiopulmonary bypass, S100B levels 1 hour later and the age of the patients were found to explain part of the neuropsychological deterioration (r = 0.49, p < 0.005). CONCLUSIONS: In this study we found that S100B levels 1 hour after surgery seem to be the most informative. Our attempt to control the increased levels of S100B caused by contamination from the surgical field did not yield different results. We conclude that the clinical value of S100B as a predictive measurement of postoperative cognitive dysfunction after cardiac surgery is limited

Neuropsychological Function After Coronary Artery Bypass Grafting

Despite considerable research efforts, the incidence and mechanisms of diffuse cognitive impairment after coronary artery bypass surgery are not fully understood. The aim of the dissertation was to describe cognitive changes after coronary artery bypass grafting (CABG) and the predictors and consequences thereof. Neuropsychological tests, interviews and questionnaires were used to assess objective and subjective cognitive function after coronary artery bypass surgery. Protein S100B was also evaluated as a possible biochemical marker for cognitive function, mortality, and emotional state. The results can be summed up in the following four points: 1. The choice of statistical definition and neuropsychological methods were significant predictors of the incidence of cognitive impairment after coronary artery bypass surgery. 2. There were no differences in subjective patient or spouse ratings of memory, concentration, emotional well-being, social functioning and general health 1-2 years after coronary artery bypass surgery and percutaneous transluminal coronary angioplasty. Only in memory function did patients and spouses report a postprocedural decline. 3. Elevated serum levels of protein S100B (>.3µg/L) 38-42 hours after cardiac surgery were an independent predictor of mortality 1-3 years after surgery. 4. After 3-6 years, patients with elevated S100B 38-42 hours after cardiac surgery had significantly higher state and trait anxiety compared with patients without elevated S100B levels. S100B was an independent predictor of state and trait anxiety. Patients with elevated S100B levels also rated their physical health as poorer. There were no differences in neuropsychological test performance, depression or blind interviewer ratings between the two groups. In conclusion, statistical and neuropsychological methods are decisive factors in defining the incidence of cognitive impairment after coronary artery bypass surgery. There were no differences in subjective measures of well-being in patients undergoing coronary artery bypass surgery compared with a comparable nonsurgical control group. Both groups reported a decrease in memory function; spouse and patient ratings were in agreement. Elevated S100B two days after surgery was a significant predictor of long-term mortality and anxiety, but not of neuropsychological function. The cause of the postoperative S100B elevation is largely unknown

Patienterna som sökte behandling hos Mendly

Kartläggning av patientpopulation, sökorsaker och behandlingsutfall i Mendly, en svensk offentligt finansierad leverantör av asynkron chattbaserad kognitiv beteendeterapi (KBT)

Protein S100B after cardiac surgery: An indicator of long-term anxiety?

Objectives. The aim of the study was to assess long-term state and trait anxiety in cardiac surgical risk patients. Design. Thirty two patients with serum S100B > 0.3 mu g/l 48 hours after cardiac surgery with cardiopulmonary bypass were matched according to age, gender, type, date and length of surgery with 35 operated patients without elevated S100B. They completed Spielberger's Anxiety Inventory (STAI). Results. Patients with elevated S100B reported more state anxiety and trait anxiety. S100B was an independent predictor of both state and trait anxiety when controlling for perioperative variables. Conclusions. Patients with elevated S100B reported more anxiety 3-6 years after cardiac surgery. A postoperative blood sample can identify risk patients and facilitate appropriate follow-up