Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials
Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials
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DOI：
10.1515/cclm-2015-1012
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发表时间：
2016-10-01
影响因子：
6.8
通讯作者：
Rex, Steffen
中科院分区：
文献类型：
--
作者：
Al Tmimi, Layth;Van de Velde, Marc;Rex, Steffen
背景资料：探讨S100（神经胶质细胞损伤的生化标志物）的预测值为发生术后谵妄（POD）的患者接受非体外循环冠状动脉搭桥术（OPCAB）-surgery.Methods：我们纳入了92例年龄大于18岁的择期OPCAB手术。在基线（BL）、手术结束（EOS）和术后第一天（PD 1）测定血清S100水平。术后每天对所有患者进行评估，直到PD 5，使用混淆评估方法（CAM）或重症监护室（ICU）患者的混淆评估方法（CAM-ICU）评估POD的存在。PD 1上的S100值显著预测后期住院期间POD的发生[曲线下面积（AUC）=0.724（95%置信区间（CI）：0.619-0.814）; p=0.0001]，最佳临界值为123 pg mL（-1）（灵敏度100%，特异性44%）。低于该值，在43.66%的无POD患者中正确预测了POD的缺失[阴性预测值（NPV）为100%（95%CI：88.8%-100.0%）-阳性预测值为29.8%（95%CI：18.4%-43.4%），阴性结果的似然比（LR）为0.0]。
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