The significance of S100β and neuron-specific enolase (NSE) in postoperative cognitive dysfunction following cardiac surgery: a systematic review and meta-analysis.

Mahsa Rostami Ghezeljeh, Farbod Khosravi, Mastooreh Sagharichi, Pooya Eini, Mahsa Asadi Anar, Athena Fahami, Sadaf Salehi, Alireza Mohebbi, Seyyed Kiarash Sadat Rafiei, Mehdi Hassani Ahangar, Amirreza Khalaji, Seyed Mohammad Mozaffari, Kourosh Amirian Shayesteh, Ilnaz Alavi, Armina Torabian, Ali Rahi, Komeil Aghazadeh-Habashi

Journal: European journal of medical research 2025;30(1):811

PMID: 40855344

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Abstract

BACKGROUND

Postoperative cognitive dysfunction (POCD) significantly affects recovery, hospitalization duration, and quality of life following cardiac surgery. Identifying reliable biomarkers for predicting POCD could improve patient outcomes and perioperative care. Among these, S100 calcium-binding protein beta (S100β) and neuron-specific enolase (NSE) have emerged as promising indicators of cerebral injury and neurocognitive dysfunction.

OBJECTIVES

This systematic review and meta-analysis aimed to assess within-subject perioperative changes in S100β and NSE levels among patients who developed POCD after cardiac surgery, to evaluate whether these biomarkers consistently rise in association with POCD.

METHODS

Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science up to October 2024. Studies included peer-reviewed articles evaluating S100β and NSE levels in relation to POCD in cardiac surgery patients. Two reviewers independently extracted data and assessed the quality using the ROBINS-I tool. Meta-analyses were conducted using a random-effects model.

RESULTS

Thirty studies were included. Among patients who developed POCD, both S100β and NSE levels were significantly elevated postoperatively compared to preoperative baselines. The pooled standardized mean difference (SMD) was 1.52 (95% CI 0.57-2.48; I = 93.1%) for S100β and 1.19 (95% CI 0.42-1.96; I = 88.7%) for NSE, indicating large effect sizes. Sensitivity analyses confirmed the robustness of these findings despite substantial heterogeneity.

CONCLUSIONS

Among patients who developed POCD, S100β and NSE levels significantly increased from preoperative to postoperative measurements, indicating a potential association with cerebral injury. However, as non-POCD patients were not analyzed for the same biomarker changes, causality or specificity to POCD cannot be confirmed and future research should be directed toward between group changes.

Address: School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.; Student Research Committee, Isfahan University of Medical Science, Isfahan, Iran.; Medical Faculty, Kazerun Branch, Islamic Azad University, Kazerun, Iran.; Cardiovascular Division, University of Louisville, Kentucky, USA.; Student Research Committee, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran.; Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.; Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.; School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.; Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.; Students Research Committee, Ardabil University of Medical Sciences, Ardabil, Iran.; School of Medicine, Iran University of Medical Sciences, Tehran, Iran.; School of Medicine, Tehran Islamic Azad University of Medical Sciences, Tehran, Iran.; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. [email protected].; Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.; School of medicine,Shahid Beheshti University of Medical Sciences, Tehran, Iran.

DOI: 10.1186/s40001-025-03081-6

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https://medlineplus.gov/aftersurgery.html

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https://assays.cancer.gov/non-CPTAC-3313

MeSH Terms: Humans, Phosphopyruvate Hydratase, S100 Calcium Binding Protein beta Subunit, Cardiac Surgical Procedures, Biomarkers, Postoperative Cognitive Complications, Postoperative Complications