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

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)

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)

Affect regulation and exhaustion disorder: what's the connection?

Denna studie undersöker om det finns en koppling mellan minskade symtom av utmattningssyndrom och förbättrad affektreglering. Tjugosex patienter med utmattningssyndrom utifrån Socialstyrelsens kriterier deltog i 6 till 14 KBT- (11 patienter) eller PDT/IPT-fokuserade (15 patienter) behandlingstillfällen som fokuserade på symtomlindring och ökad uppmärksamhet på olika kroppsliga sensationer: utmattning, stressnivå och känslor. Frågeformulären KEDS, DERS och HADS fylldes i vid början och slutet av behandlingen samt vid tremånaders-uppföljningen. Patientgruppen visade en signifikanta förbättringar på samtliga skalor, dvs de självskattade måtten på stressrelaterad utmattning, affektreglering samt ångest och depression, efter behandlingen och vid tremånaders-uppföljningen. Medelvärdena för affektreglering var över skalans kritiska gräns vid alla tre mättillfällena, vilket indikerar sämre affektreglering för dessa deltagare med utmattningssyndrom. Studiens resultat indikerar att det finns en koppling mellan affektreglering och utmattning. Även om resultaten inte kan visa på kausalitet, indikerar studiens fynd att båda parametrar kan mediera varandra. Sammanfattningsvis visar studien på att behandling som fokuserar på att öka en individs förmåga till hälsosam affektreglering kan vara en salutogen faktor för stresshantering.The present study examines if there is a link between symptom reduction of exhaustion and improved affect regulation. Twenty-six patients with exhaustion disorder according to National Board of Health and Welfare (NBHW) criteria participated in 6 to 14 CBT-based (11 patients) or PDT/IPT-based treatment (15 patients) sessions focusing on symptom reduction and attunement to various bodily sensations: fatigue, stress level and emotion. The questionnaires KEDS, DERS and HADS were collected at the start of treatment, at the end of treatment and at a three-month follow-up. The patient group showed significant improvement on all self-rated health questionnaires, i.e. level of exhaustion, affect regulation, depression and anxiety, after treatment and at three-month follow-up. Emotion regulation means were above the cutoff at all three intervals, indicating poorer emotion regulation for this sample of participants with exhaustion disorder. Hence, the results suggest that there is a connection between emotion regulation and exhaustion. Though causality cannot be presumed, the findings support that both parameters may mediate the other. In summary, the study’s clinical implication is that enhancing an individual’s capacity for healthy emotion regulation could be a salutogenic factor for stress management

God livskvalitet efter hjärtoperation. Bedöms lika av patient och anhörig

In a series of 83 patients undergoing coronary artery bypass grafting for angina, perceived QOL (quality of life) was rated by the patients and their spouses, preoperatively and at two and 12 months postoperatively, using the SWED-QUAL instrument. One year after surgery, QOL had improved to a level which might be expected of a normal population comparable in age and gender distribution. Good correlation existed between patient and spouse ratings, especially on physical measures

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

S100beta after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome

BACKGROUND: S100beta has been suggested as a marker of brain damage after cardiac operation. The aim of this study was to characterize the early S100beta release in detail and relate it to neuropsychological outcome. METHODS: Three groups of patients were investigated. All patients underwent coronary artery bypass surgery (CABG) with extracorporeal circulation. In group A, 110 patients had sampling of S100beta for the first 10 postoperative hours and also underwent neuropsychological testing. In group B, 14 patients were examined for the effect of autotransfusion on S100beta levels. Eight patients in group C had their intraoperative bleeding processed with a cell-saving device. RESULTS: Group A had a heterogeneous release pattern with several rapid elevations in S100beta concentration. In group B, high concentrations of S100beta were found in the autotransfusion blood (range 0.2 to 210 microg/L) with a concurrent elevation of serum S100beta levels after transfusion of shed blood. In group C, high levels of S100beta were found in the blood from the surgical field (12.0+/-6.0 microg/L) and decreased (1.1+/-0.64 microg/L) after wash. Group C had significantly lower S100beta values at the end of cardiopulmonary bypass compared to group A (0.53+/-0.35 microg/L versus 2.40+/-1.5 microg/L). S100beta values were corrected for extracerebral contamination with a kinetic model. With this correction, an association was found between adverse neuropsychological outcome and S100beta release in group A (r = 0.39, p < 0.02). CONCLUSIONS: A significant amount of S100beta is found both in the blood from the surgical field and in the shed mediastinal blood postoperatively. Infusion of this blood will result in infusion of S100beta into the blood and interfere in the interpretation of early systemic S100beta values