Abstract
Background:
To investigate the predictive value of S100 (biochemical marker of neuroglial injury) for the occurrence of postoperative delirium (POD) in patients undergoing off-pump coronary artery bypass (OPCAB)-surgery.
Methods:
We enrolled 92 patients older than 18 years undergoing elective OPCAB-surgery. Serum-levels of S100 were determined at baseline (BL), end of surgery (EOS) and on the first postoperative day (PD1). Postoperatively, all-patients were evaluated daily until PD5 for the presence of POD using the confusion assessment method (CAM) or the confusion assessment method for the intensive care unit (CAM-ICU) for patients in the intensive care unit (ICU).
Results:
The overall incidence of POD was 21%. S100-values on PD1 significantly predicted the occurrence of POD during the later hospital stay [area under the curve (AUC)=0.724 (95% confidence interval (CI): 0.619–0.814); p=0.0001] with an optimal cut-off level of 123 pg mL−1 (sensitivity 100%, specificity 44%). Below this value, the absence of POD was predicted correctly in 43.66% of patients without POD [negative predictive value (NPV) of 100% (95%CI: 88.8%–100.0%) – positive predictive value of 29.8% (95%CI: 18.4%–43.4%) and likelihood ratio (LR) of the negative result of 0.0].
Conclusions:
S100-levels <123 pg mL−1 measured on PD1 reliably rule out the development of POD after elective OPCAB-surgery. This finding warrants testing whether S100-levels could be used for a risk stratification of cardiac surgical patients and for the initiation of preventive measures against POD in patients with high postoperative S100-levels.
Acknowledgments
The authors would like to thank the research nurses Christel Huygens and Punitha Vandenbempt and the laboratory technician Julie Oosterlynck for their hard work and valuable assistance with this study.
Author contributions: SR is the principle investigator of this observational study. SR, LA, MVDV, KM, HP and KP contributed to the study design and protocol. LA, KP and SR carried out the clinical examination, the data acquisition and drafted the manuscript. LA, KP, SR, HP performed the statistical analysis. KP supervised the laboratory analysis. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: The study is mostly funded by institutional and departmental sources. KP has received lecture fees from Roche Diagnostics Belgium that also provided the S100 reagent. SR is supported by the “Foundation Annie Planckaert-Dewaele” (Biomedical Sciences Group, KU Leuven), by a research grant of AirLiquide, Belgium and by a clinical research fund of University Hospitals Leuven. KP is supported by the start-up grant of the Group of Biomedical Sciences KU Leuven and by a clinical research fund of University Hospitals Leuven. The funding institutions had no influence on the design, analysis or publication of the study.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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Article note:
Preliminary results of this study were presented as oral presentation at the Annual Congress of the European Association of Cardiothoracic Anaesthesiologists (EACTA) on 24 June 2015 in Gothenburg, Sweden; and at the 2015 International Scientific Conference for Biochemical Markers of Brain Damage in Lund, Sweden.
©2016 Walter de Gruyter GmbH, Berlin/Boston
