Biochemical markers of neurologic injury in cardiac surgery: The rise and fall of S100β

摘要: Dr Vaage W ith the change in patient population toward older and sicker patients undergoing cardiac surgery, neurologic injury has emerged as perhaps most important perioperative complication, its frequency increases exponentially with increasing age.1 Particular attention been paid to role of cardiopulmonary bypass per se2 thromboembolization from ascending aorta.3 However, is not limited only stroke coma1; increasingly there a focus on more subtle neurocognitive dysfunction consequences quality life.4,5 The majority cases gross do represent diagnostic problem, at time diagnosis usually manifest irreversible. Neurocognitive dysfunction, however, less accessible for quantification, which requires time-consuming neuropsychologic testing. With few exceptions, such testing unavailable surgeon. Prompted by awareness injury, well emergence minimally invasive present an interest cognitive will remain research method available everyday clinical practice because manpower it consumes. A biochemical marker blood patients—“a troponin brain”— would revolution investigation surgery. serum could potentially identify aspect(s) surgery are responsible evaluate efficacy alternative surgical techniques. Additionally, if concentrations during or directly after be related shown predict that became clinically evident some hours (or days), then neuroprotective interventions might indicated. ideal should have following properties: 1. Central nervous specificity 2. Rapid significant release into preferably within minutes 3. Elimination 4. Rapidly readily obtainable assay results 5. Predictability serious early sample, eg, end 6. Relationship concentration degree quantifying full range deficits 7. Inexpensive During past two decades variety substances suggested possible markers brain adenylate kinase, creatinine phosphokinase isoenzyme BB, lactate, myelin basic protein, S100 , neuronspecific enolase.6 Recently, glial fibrillary acidic protein added this list,7 but potential unknown. Most these methodologic problems: instance, kinase lactate sampled cerebrospinal fluid, BB lacks specificity. value neuron-specific enolase was also recently doubtful association hemolysis caused destruction erythrocytes.8 appeared fulfill many above criteria marker.6,9,10 From Departments Thoracic Surgery Anaesthetics Intensive Care, Karolinska Hospital, Stockholm, Sweden.