Correlation of Neuron-Specific Enolase and S100ß Protein Levels, Inflammatory Cytokines, and Neurological Injury in Children Undergoing Cardiopulmonary Bypass.

BACKGROUND

The systemic inflammatory response syndrome to cardiopulmonary bypass (CPB) affects all organ systems including the brain. Perioperative brain injury in children with congenital heart disease is often clinically silent in the acute perioperative period and may not be detected until patients are older. The plasma biomarkers neuron-specific enolase (NSE) and S100ß protein show potential for detecting neurological injury in the perioperative period.

OBJECTIVES

The three objectives of this study were to examine the correlation of NSE and S100ß protein levels with inflammatory cytokines, parameters of CPB, and the development of neurological injury in the intensive care unit following cardiac surgery in children.

METHODS

50 children undergoing cardiac surgery with CPB had blood samples drawn at three time points: after induction of anesthesia, 30 min post-CPB, and 24 h post-CPB. Blood samples were analyzed for NSE, S100ß, and the inflammatory cytokines IL-6, IL-8, and IL-10. Data were collected on CPB durations and neurological injury diagnosed in the postoperative period.

RESULTS

NSE and S100ß increased significantly following bypass and correlated with increases of IL-6, IL-8, and IL-10. There was a significant positive correlation of NSE and S100ß with duration of CPB, and of S100ß with duration of aortic cross clamp. Three patients suffered neurological insult. These patients had greater levels of NSE during the post-CPB period (p = 0.02) and S100ß at 24 h post-CPB (p = 0.02) than patients without neurological deficits.

CONCLUSION

The positive correlation between NSE, S100ß, inflammatory cytokines, and neurological deficits suggests that the systemic inflammatory response to CPB may contribute to neurological injury and that NSE and S100ß may be useful tools to detect neurological injury following CPB.