RESUMO
This prospective study evaluated the prognostic value of early neurobiochemical markers, neuron-specific enolase and astroglial protein S-100B, for long-term cognitive outcome after cardiac arrest. Six months after admission of a cohort of 80 consecutive patients, 26 survivors were able to undergo a neuropsychological test battery. Survivors showed low test performances in attention, learning/memory, and executive functioning. Neuropsychological bedside screening during the first month significantly differentiated between patients with and without long-term cognitive impairment. The neurobiochemical marker S-100B at day 3 after admission was found to predict significant proportions of variance in specific cognitive domains (learning/memory and executive functioning). The results indicate that early neuropsychological assessment might help identify patients who run at risk of long-term neuropsychological dysfunction. This study also suggests that especially the protein S-100B provides valuable information on long-term cognitive outcomes. To understand the exact relationship, results have to be replicated in larger trials.
Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Parada Cardíaca/complicações , Adulto , Idoso , Análise de Variância , Atenção/fisiologia , Transtornos Cognitivos/metabolismo , Estudos de Coortes , Feminino , Parada Cardíaca/metabolismo , Humanos , Aprendizagem/fisiologia , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Destreza Motora/fisiologia , Fatores de Crescimento Neural/sangue , Testes Neuropsicológicos , Fosfopiruvato Hidratase/sangue , Valor Preditivo dos Testes , Resolução de Problemas/fisiologia , Curva ROC , Análise de Regressão , Estudos Retrospectivos , Subunidade beta da Proteína Ligante de Cálcio S100 , Proteínas S100/sangue , Fatores de Tempo , Percepção Visual/fisiologiaRESUMO
OBJECTIVE: To determine the prognostic accuracy of biochemical, clinical, electrophysiological, and neuropsychological investigations in predicting outcomes after cardiac arrest. DESIGN: Prospective study. SETTING: Intensive care unit of the Hamburg-Eppendorf University Medical Center, Hamburg, Germany. PATIENTS: A total of 80 patients (mean age, 63.79 +/- 15.85 yrs) after cardiopulmonary resuscitation. INTERVENTIONS: Serial blood samples (days 2-4), clinical examinations (days 2 and 4), sensory-evoked potentials (day 4), and neuropsychological assessments (Assuntos
Reanimação Cardiopulmonar
, Potenciais Somatossensoriais Evocados
, Parada Cardíaca/terapia
, Fatores de Crescimento Neural/sangue
, Testes Neuropsicológicos
, Fosfopiruvato Hidratase/sangue
, Proteínas S100/sangue
, Adolescente
, Adulto
, Idoso
, Idoso de 80 Anos ou mais
, Biomarcadores/sangue
, Coma
, Feminino
, Parada Cardíaca/sangue
, Parada Cardíaca/fisiopatologia
, Humanos
, Modelos Logísticos
, Masculino
, Pessoa de Meia-Idade
, Análise Multivariada
, Prognóstico
, Modelos de Riscos Proporcionais
, Estudos Prospectivos
, Curva ROC
, Subunidade beta da Proteína Ligante de Cálcio S100
, Sensibilidade e Especificidade
, Resultado do Tratamento