Skip to main content
SpringerLink
Log in

Bispectral index predicts deaths within 2 weeks in coma patients, a better predictor than serum neuron-specific enolase or S100 protein

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

We assessed the ability of bispectral index (BIS) to predict clinical outcome (dead or alive within 2 weeks).

Methods

In total, 90 coma patients with severe brain injuries underwent BIS monitoring, and serum neuron-specific enolase (NSE) and S100 protein levels were assayed within the first 3 days of admission. Receiver operator characteristic (ROC) curve analysis was used to assess the performance of BIS values for predicting death within 2 weeks. A cutoff value was calculated using the Youden index.

Results

A significant negative correlation was found between BIS value and serum NSE and S100 levels. The area under the curve for BIS value was 0.841 (p < 0.001, 95 % CI = 0.751–0.931), and higher than for NSE (0.713) (p = 0.002, 95 % CI = 0.582–0.844) or S100 (0.790) (p < 0.001, 95 % CI = 0.680–0.899). The optimal cutoff of BIS was 32.5. Serum NSE and S100 protein levels and the mortality rate were significantly lower in patients with a BIS value >32.5 than in patients with a BIS value ≤32.5.

Conclusions

Bispectral index values may reflect degree of brain injury, and BIS is an objective and noninvasive monitoring method for helping clinicians to predict death in patients with a BIS value ≤32.5.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Joosse P, Smit G, Arendshorst RJ, Soedarmo S, Ponsen KJ, Goslings JC. Outcome and prognostic factors of traumatic brain injury: a prospective evaluation in a Jakarta University hospital. J Clin Neurosci. 2009;16:925–8.

    Article  CAS  PubMed  Google Scholar 

  2. Dworschak M, Franz M, Czerny M, Gorlitzer M, Blaschek M, Grubhofer G, Haider W. Release of neuron-specific enolase and S100 after implantation of cardioverters/defibrillators. Crit Care Med. 2003;31:2085–9.

    Article  CAS  PubMed  Google Scholar 

  3. Bohmer AE, Oses JP, Schmidt AP, Peron CS, Krebs CL, Oppitz PP, D’Avila TT, Souza DO, Portela LV, Stefani MA. Neuron-specific enolase, S100B, and glial fibrillary acidic protein levels as outcome predictors in patients with severe traumatic brain injury. Neurosurgery. 2011;68:1624–30 discussion 30–31.

    Article  PubMed  Google Scholar 

  4. Missler U, Wiesmann M, Friedrich C, Kaps M. S-100 protein and neuron-specific enolase concentrations in blood as indicators of infarction volume and prognosis in acute ischemic stroke. Stroke. 1997;28:1956–60.

    Article  CAS  PubMed  Google Scholar 

  5. Shinozaki K, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Abe R, Tateishi Y, Hattori N, Shimada T, Hirasawa H. S-100B and neuron-specific enolase as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation: a systematic review. Crit Care. 2009;13:R121.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Gao F, Harris DN, Sapsed-Byrne S. Time course of neurone-specific enolase and S-100 protein release during and after coronary artery bypass grafting. Br J Anaesth. 1999;82:266–7.

    Article  CAS  PubMed  Google Scholar 

  7. Oertel M, Schumacher U, McArthur DL, Kastner S, Boker DK. S-100B and NSE: markers of initial impact of subarachnoid haemorrhage and their relation to vasospasm and outcome. J Clin Neurosci. 2006;13:834–40.

    Article  CAS  PubMed  Google Scholar 

  8. Moritz S, Warnat J, Bele S, Graf BM, Woertgen C. The prognostic value of NSE and S100B from serum and cerebrospinal fluid in patients with spontaneous subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2010;22:21–31.

    Article  PubMed  Google Scholar 

  9. Olivecrona M, Rodling-Wahlstrom M, Naredi S, Koskinen LO. S-100B and neuron specific enolase are poor outcome predictors in severe traumatic brain injury treated by an intracranial pressure targeted therapy. J Neurol Neurosurg Psychiatry. 2009;80:1241–7.

    Article  CAS  PubMed  Google Scholar 

  10. Ogilvie MP, Pereira BM, Ryan ML, Gomez-Rodriguez JC, Pierre EJ, Livingstone AS, Proctor KG. Bispectral index to monitor propofol sedation in trauma patients. J Trauma. 2011;71:1415–21.

    Article  PubMed  Google Scholar 

  11. Rosow C, Manberg PJ. Bispectral index monitoring. Anesthesiol Clin N Am 2001;19:947–966, xi

    Google Scholar 

  12. Dunham CM, Ransom KJ, McAuley CE, Gruber BS, Mangalat D, Flowers LL. Severe brain injury ICU outcomes are associated with cranial-arterial pressure index and noninvasive bispectral index and transcranial oxygen saturation: a prospective, preliminary study. Crit Care. 2006;10:R159.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Paul DB, Umamaheswara Rao GS. Correlation of bispectral index with Glasgow Coma Score in mild and moderate head injuries. J Clin Monit Comput. 2006;20:399–404.

    Article  PubMed  Google Scholar 

  14. Umegaki N, Hirota K, Kitayama M, Yatsu Y, Ishihara H, Mtasuki A. A marked decrease in bispectral index with elevation of suppression ratio by cervical haematoma reducing cerebral perfusion pressure. J Clin Neurosci. 2003;10:694–6.

    Article  CAS  PubMed  Google Scholar 

  15. Fabregas N, Gambus PL, Valero R, Carrero EJ, Salvador L, Zavala E, Ferrer E. Can bispectral index monitoring predict recovery of consciousness in patients with severe brain injury? Anesthesiology. 2004;101:43–51.

    Article  PubMed  Google Scholar 

  16. Gilbert TT, Wagner MR, Halukurike V, Paz HL, Garland A. Use of bispectral electroencephalogram monitoring to assess neurologic status in unsedated, critically ill patients. Crit Care Med. 2001;29:1996–2000.

    Article  CAS  PubMed  Google Scholar 

  17. Schnakers C, Ledoux D, Majerus S, Damas P, Damas F, Lambermont B, Lamy M, Boly M, Vanhaudenhuyse A, Moonen G, Laureys S. Diagnostic and prognostic use of bispectral index in coma, vegetative state and related disorders. Brain Inj. 2008;22:926–31.

    Article  CAS  PubMed  Google Scholar 

  18. Stammet P, Werer C, Mertens L, Lorang C, Hemmer M. Bispectral index (BIS) helps predicting bad neurological outcome in comatose survivors after cardiac arrest and induced therapeutic hypothermia. Resuscitation. 2009;80:437–42.

    Article  PubMed  Google Scholar 

  19. Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, Murray GD, Maas AI. Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg. 2003;99:666–73.

    Article  PubMed  Google Scholar 

  20. Flaada JT, Leibson CL, Mandrekar JN, Diehl N, Perkins PK, Brown AW, Malec JF. Relative risk of mortality after traumatic brain injury: a population-based study of the role of age and injury severity. J Neurotrauma. 2007;24:435–45.

    Article  PubMed  Google Scholar 

  21. Carolei A, Marini C, Ferranti E, Frontoni M, Prencipe M, Fieschi C. A prospective study of cerebral ischemia in the young. Analysis of pathogenic determinants. The national research council study group. Stroke. 1993;24:362–7.

    Article  CAS  PubMed  Google Scholar 

  22. Hallevy C, Ifergane G, Kordysh E, Herishanu Y. Spontaneous supratentorial intracerebral hemorrhage. Criteria for short-term functional outcome prediction. J Neurol. 2002;249:1704–9.

    Article  PubMed  Google Scholar 

  23. Meynaar IA, Oudemans-van Straaten HM, van der Wetering J, Verlooy P, Slaats EH, Bosman RJ, van der Spoel JI, Zandstra DF. Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study. Intensive Care Med. 2003;29:189–95.

    PubMed  Google Scholar 

  24. Zandbergen EG, de Haan RJ, Hijdra A. Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage. Intensive Care Med. 2001;27:1661–7.

    Article  CAS  PubMed  Google Scholar 

  25. Pelinka LE, Hertz H, Mauritz W, Harada N, Jafarmadar M, Albrecht M, Redl H, Bahrami S. Nonspecific increase of systemic neuron-specific enolase after trauma: clinical and experimental findings. Shock. 2005;24:119–23.

    Article  CAS  PubMed  Google Scholar 

  26. Kleine TO, Benes L, Zofel P. Studies of the brain specificity of S100B and neuron-specific enolase (NSE) in blood serum of acute care patients. Brain Res Bull. 2003;61:265–79.

    Article  CAS  PubMed  Google Scholar 

  27. Liu J, Singh H, White PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg. 1997;84:185–9.

    CAS  PubMed  Google Scholar 

  28. Gan TJ, Glass PS, Windsor A, Payne F, Rosow C, Sebel P, Manberg P. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology. 1997;87:808–15.

    Article  CAS  PubMed  Google Scholar 

  29. Gajraj RJ, Doi M, Mantzaridis H, Kenny GN. Analysis of the EEG bispectrum, auditory evoked potentials and the EEG power spectrum during repeated transitions from consciousness to unconsciousness. Br J Anaesth. 1998;80:46–52.

    Article  CAS  PubMed  Google Scholar 

  30. Simmons LE, Riker RR, Prato BS, Fraser GL. Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale. Crit Care Med. 1999;27:1499–504.

    Article  CAS  PubMed  Google Scholar 

  31. Guan W, Yang YL, Xia WM, Li L, Gong DS. Significance of serum neuron-specific enolase in patients with acute traumatic brain injury. Chin J Traumatol. 2003;6:218–21.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Intensive Care Unit, Hospital No. 401 of the Chinese People’s Liberation Army, Minjiang Road 22, Qingdao, 266071, Shandong, China

    Wenli Miao & Hailing Li

  2. Department of Anesthesia, Hand Surgery Center of General Army, Hospital No. 401 of the Chinese People’s Liberation Army, Minjiang Road 22, Qingdao, 266071, Shandong, China

    Yuanxin Zhang

Authors
  1. Wenli Miao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuanxin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hailing Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wenli Miao.

About this article

Cite this article

Miao, W., Zhang, Y. & Li, H. Bispectral index predicts deaths within 2 weeks in coma patients, a better predictor than serum neuron-specific enolase or S100 protein. J Anesth 27, 855–861 (2013). https://doi.org/10.1007/s00540-013-1654-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-013-1654-0

Keywords

Search

Navigation