Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest

Levin, Helena; Lybeck, Anna; Frigyesi, Attila; Arctaedius, Isabelle; Thorgeirsdóttir, Bergthóra; Annborn, Martin; Moseby-Knappe, Marion; Nielsen, Niklas; Cronberg, Tobias; Ashton, Nicholas J.; Zetterberg, Henrik; Blennow, Kaj; Friberg, Hans; Mattsson‐Carlgren, Niklas

doi:10.1186/s13054-023-04355-3

Cited by 13 publications

(12 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…42 Further, NfL has been proposed as a prognostic marker for short and long-term neurological outcomes exceeding cardiac arrest. 43 The review is not without limitations. In only a few studies, prognostic value of NfL was the primary outcome.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic value of neurofilament light in blood in patients with polyneuropathy: A systematic review

Kodal,

Witt,

Pedersen

et al. 2023

J Peripheral Nervous Sys

View full text Add to dashboard Cite

Neurofilament light protein (NfL) is a part of the neuronal skeleton, primarily expressed in axons, and is released when nerves are damaged. NfL has been found to be a potential diagnostic biomarker in different types of polyneuropathies. However, whether NfL levels can be used as a predictor for the risk of disease progression is currently less understood. We searched MEDLINE (PubMed), Embase, Cochrane Library, and Web of Science Searches and included longitudinal studies with a baseline and follow‐up examination of adult patients with polyneuropathy and NfL measured in blood. Twenty studies investigating NfL as a predictor of disease progression were identified, examining eight polyneuropathy subtypes. The results from studies in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) patients were divergent, with two out of five studies finding a significant association between NfL levels and clinical outcomes. Meta‐analysis of the three Guillian‐Barré Syndrome (GBS) studies found higher odds for the inability to run after 1 year in patients with high levels of NfL (odds ratio 2.18, 95% confidence interval 1.04–4.56). Results from studies examining other subacute or chronic polyneuropathies like Charcot–Marie–Tooth (CMT) varied in study design and results. Our findings suggest NfL can be used as a predictor of disease progression, particularly in polyneuropathies such as CIDP and GBS. However, NfL may not serve as a reliable and cost‐effective biomarker for slowly progressive polyneuropathies like CMT. Future standardized studies considering NfL as a prognostic blood biomarker in patients with different types of polyneuropathies are warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In Multiple Sclerosis, NfL in blood approaches clinical practice as a diagnostic and prognostic biomarker with several studies highlighting its predictive value 42 . Further, NfL has been proposed as a prognostic marker for short and long‐term neurological outcomes exceeding cardiac arrest 43 …”

Section: Discussionmentioning

confidence: 99%

Prognostic value of neurofilament light in blood in patients with polyneuropathy: A systematic review

Kodal,

Witt,

Pedersen

et al. 2023

J Peripheral Nervous Sys

View full text Add to dashboard Cite

show abstract

“…Additionally, we wanted to test if a combination of biomarkers originating from astroglial cells and neurons improved prediction compared to individual biomarkers. We, therefore, tested a combination of GFAP and tau and a combination of GFAP and NFL, considering previously described very high predictive values of NFL at 12 h in the same patients [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Plasma glial fibrillary acidic protein and tau: predictors of neurological outcome after cardiac arrest

Arctaedius,

Levin,

Thorgeirsdóttir

et al. 2024

Crit Care

Self Cite

View full text Add to dashboard Cite

Background The purpose was to evaluate glial fibrillary acidic protein (GFAP) and total-tau in plasma as predictors of poor neurological outcome after out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA), including comparisons with neurofilament light (NFL) and neuron-specific enolase (NSE). Methods Retrospective multicentre observational study of patients admitted to an intensive care unit (ICU) in three hospitals in Sweden 2014–2018. Blood samples were collected at ICU admission, 12 h, and 48 h post-cardiac arrest. Poor neurological outcome was defined as Cerebral Performance Category 3–5 at 2–6 months after cardiac arrest. Plasma samples were retrospectively analysed for GFAP, tau, and NFL. Serum NSE was analysed in clinical care. Prognostic performances were tested with the area under the receiver operating characteristics curve (AUC). Results Of the 428 included patients, 328 were OHCA, and 100 were IHCA. At ICU admission, 12 h and 48 h post-cardiac arrest, GFAP predicted neurological outcome after OHCA with AUC (95% CI) 0.76 (0.70–0.82), 0.86 (0.81–0.90) and 0.91 (0.87–0.96), and after IHCA with AUC (95% CI) 0.77 (0.66–0.87), 0.83 (0.74–0.92) and 0.83 (0.71–0.95). At the same time points, tau predicted outcome after OHCA with AUC (95% CI) 0.72 (0.66–0.79), 0.75 (0.69–0.81), and 0.93 (0.89–0.96) and after IHCA with AUC (95% CI) 0.61 (0.49–0.74), 0.68 (0.56–0.79), and 0.77 (0.65–0.90). Adding the change in biomarker levels between time points did not improve predictive accuracy compared to the last time point. In a subset of patients, GFAP at 12 h and 48 h, as well as tau at 48 h, offered similar predictive value as NSE at 48 h (the earliest time point NSE is recommended in guidelines) after both OHCA and IHCA. The predictive performance of NFL was similar or superior to GFAP and tau at all time points after OHCA and IHCA. Conclusion GFAP and tau are promising biomarkers for neuroprognostication, with the highest predictive performance at 48 h after OHCA, but not superior to NFL. The predictive ability of GFAP may be sufficiently high for clinical use at 12 h after cardiac arrest.

show abstract

“…The results of the present study on broadening the entry criteria to the ERC/ESCIM 2021 algorithm for neuroprognostication should be validated in cohorts where WLST is not practiced. Improvements to neuroprognostic strategies may be provided by standardized evaluation of neuroimaging (20), quantitative methods (pupillometry), and novel biomarkers (21)(22)(23)(24)(25). Accurate neuroprognostication earlier than 72 hours may prove possible as prognostic markers improve (22,23,25,26).…”

mentioning

confidence: 99%

“…Improvements to neuroprognostic strategies may be provided by standardized evaluation of neuroimaging (20), quantitative methods (pupillometry), and novel biomarkers (21)(22)(23)(24)(25). Accurate neuroprognostication earlier than 72 hours may prove possible as prognostic markers improve (22,23,25,26).…”

mentioning

confidence: 99%

2021 European Resuscitation Council/European Society of Intensive Care Medicine Algorithm for Prognostication of Poor Neurological Outcome After Cardiac Arrest—Can Entry Criteria Be Broadened?*

Arctaedius,

Levin,

Larsson

et al. 2023

Critical Care Medicine

Self Cite

View full text Add to dashboard Cite

OBJECTIVES: To explore broadened entry criteria of the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) algorithm for neuroprognostication including patients with ongoing sedation and Glasgow Coma Scale-Motor score (GCS-M) scores 4–5. DESIGN: Retrospective multicenter observational study. SETTING: Four ICUs, Skane, Sweden. PATIENTS: Postcardiac arrest patients managed at targeted temperature 36°C, 2014–2018. Neurologic outcome was assessed after 2–6 months according to the Cerebral Performance Category scale. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In 794 included patients, median age was 69.5 years (interquartile range, 60.6–77.0 yr), 241 (30.4%) were female, 550 (69.3%) had an out-of-hospital cardiac arrest, and 314 (41.3%) had a shockable rhythm. Four hundred ninety-five patients were dead at follow-up, 330 of 495 died after a decision on withdrawal of life-sustaining therapies. At 72 hours after cardiac arrest 218 patients remained unconscious. The entry criteria of the original algorithm (GCS-M 1–3) was fulfilled by 163 patients and 115 patients with poor outcome were identified, with false positive rate (FPR) of 0% (95% CI, 0–79.4%) and sensitivity of 71.0% (95% CI, 63.6–77.4%). Inclusion of patients with ongoing sedation identified another 13 patients with poor outcome, generating FPR of 0% (95% CI, 0–65.8%) and sensitivity of 69.6% (95% CI, 62.6–75.8%). Inclusion of all unconscious patients (GCS-M 1–5), regardless of sedation, identified one additional patient, generating FPR of 0% (95% CI, 0–22.8) and sensitivity of 62.9% (95% CI, 56.1–69.2). The few patients with true negative prediction (patients with good outcome not fulfilling guideline criteria of a poor outcome) generated wide 95% CI for FPR. CONCLUSION: The 2021 ERC/ESICM algorithm for neuroprognostication predicted poor neurologic outcome with a FPR of 0%. Broadening inclusion criteria to include all unconscious patients regardless of ongoing sedation identified an additional small number of patients with poor outcome but did not affect the FPR. Results are limited by high rate of withdrawal of life-sustaining therapies and few patients with true negative prediction.

show abstract

Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest

Cited by 13 publications

References 31 publications

Prognostic value of neurofilament light in blood in patients with polyneuropathy: A systematic review

Prognostic value of neurofilament light in blood in patients with polyneuropathy: A systematic review

Plasma glial fibrillary acidic protein and tau: predictors of neurological outcome after cardiac arrest

2021 European Resuscitation Council/European Society of Intensive Care Medicine Algorithm for Prognostication of Poor Neurological Outcome After Cardiac Arrest—Can Entry Criteria Be Broadened?*

Contact Info

Product

Resources

About