Ultra-early serum concentrations of neuronal and astroglial biomarkers predict poor neurological outcome after out-of-hospital cardiac arrest—a pilot neuroprognostic study

Huesgen, Karl; Elmelige, Yasmeen; Yang, Zhihui; Chowdhury, Muhammad Abdul Baker; Gul, Sarah; Maciel, Carolina B.; Elie‐Turenne, Marie‐Carmelle; Becker, Torben K.; Cohen, Scott; Holland, Amy; Montero, Cindy; Zhu, Tao; Wang, Kevin; Tyndall, Joseph A.; Team, Florida Cardiac Arrest Resource

doi:10.1016/j.resplu.2021.100133

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…Three studies compared the serum NfL levels across groups and time points [ 16 , 20 , 21 ]. The serum NfL levels increased immediately in patients with a poor neurological outcome at hospital admission, reached peak values from 48 to 72 h, and then gradually decreased and maintained a steady level.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies [ 15 , 16 , 18 – 21 , 23 ] involving 1020 participants reported the serum NfL 48 h post arrest for predicting the neurological outcome. Pooled analysis showed that the serum NfL 48 h post arrest was correlated with poor neurological outcome (OR = 35.69, 95% CI: 21.93–58.07, P < 0.001; I 2 = 33.1%, P = 0.176; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [ 16 , 20 , 21 ] described the dynamic change in the serum NfL levels and the corresponding predictive performance at different time points. Wihersaari et al [ 21 ] compared NfL data at four different time points (ICU admission and 24, 48 and 72 h after cardiac arrest) and indicated that the serum NfL 48 h after cardiac arrest exhibited the highest sensitivity (85%) when the specificity was set to 100%.…”

Section: Discussionmentioning

confidence: 99%

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Serum neurofilament light chain as a predictive marker of neurologic outcome after cardiac arrest: a meta-analysis

Wang

Feng

et al. 2023

BMC Cardiovasc Disord

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Objective Recently, an increasing number of studies have suggested using serum neurofilament light (NfL) chain to predict the neurologic outcome after cardiac arrest. However, the predictive ability of this approach remains inconclusive. Meta-analysis was performed on related studies to assess the ability of serum NfL to predict the neurologic outcome after cardiac arrest. Materials and methods PubMed, ScienceDirect and Embase were systematically searched from the date of their inception until June 2022. Data were extracted to calculate the area under the receiver operating characteristic curve (AUC), the sensitivity, the specificity and the publication bias to evaluate the predictive power of serum NfL using Stata 14.0. Results Nine studies were included in the present meta-analysis. Seven studies involving 1296 participants reported serum NfL 24 h post arrest for predicting the neurological outcome, and the AUC was 0.92 (77% sensitivity and 96% specificity). Seven studies involving 1020 participants reported serum NfL 48 h post arrest for predicting the neurological outcome, and the AUC was 0.94 (78% sensitivity and 98% specificity). Four studies involving 804 participants reported serum NfL 72 h post arrest for predicting the neurological outcome, and the AUC was 0.96 (90% sensitivity and 98% specificity). No significant publication bias was observed among the included studies. Conclusion The present meta-analysis results support the potential use of serum NfL as an early biomarker of neurologic outcome, especially 72 h post arrest.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Serum neurofilament light chain as a predictive marker of neurologic outcome after cardiac arrest: a meta-analysis

Wang

Feng

et al. 2023

BMC Cardiovasc Disord

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“…In our study, blood samples were drawn at 24 and 48 h after ROSC. In one study, the concentrations of UCH‐L1 in CA patients with unfavourable outcome were high already at the time of ICU admission 36 . In a study on TBI patients, the mean half‐life of UCH‐L1 in serum was 13 h and median half‐life 9 h 19 .…”

Section: Discussionmentioning

confidence: 98%

“…In one study, the concentrations of UCH-L1 in CA patients with unfavourable outcome were high already at the time of ICU admission. 36 In a study on TBI patients, the mean half-life of UCH-L1 in serum was 13 h and median half-life 9 h. 19 After hypothermic circulatory arrest in canines, serum UCH-L1 at…”

Section: Discussionmentioning

confidence: 99%

Ubiquitin C‐terminal hydrolase L1 after out‐of‐hospital cardiac arrest

Wihersaari

Reinikainen

Tiainen

et al. 2023

Acta Anaesthesiol Scand

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Background We studied the prognostic ability of serum ubiquitin C‐terminal hydrolase L1 (UCH‐L1) after out‐of‐hospital cardiac arrest (OHCA), compared to that of neuron‐specific enolase (NSE). Methods In this post‐hoc analysis of the FINNRESUSCI study, we measured serum concentrations of UCH‐L1 in 249 OHCA patients treated in 21 Finnish intensive care units in 2010–2011. We evaluated the ability of UCH‐L1 to predict unfavourable outcome at 12 months (defined as cerebral performance category 3–5) by assessing the area under the receiver operating characteristic curve (AUROC), in comparison with NSE. Results The concentrations of UCH‐L1 were higher in patients with unfavourable outcome than for those with favourable outcome: median concentration 10.8 ng/mL (interquartile range, 7.5–18.5 ng/mL) versus 7.8 ng/mL (5.9–11.8 ng/mL) at 24 h (p < .001), and 16.2 ng/mL (12.2–27.7 ng/mL) versus 11.5 ng/mL (9.0–17.2 ng/mL) (p < .001) at 48 h after OHCA. For UCH‐L1 as a 12‐month outcome predictor, the AUROC was 0.66 (95% confidence interval, 0.60–0.73) at 24 h and 0.66 (0.59–0.74) at 48 h. For NSE, the AUROC was 0.66 (0.59–0.73) at 24 h and 0.72 (0.65–0.80) at 48 h. The prognostic ability of UCH‐L1 was not different from that of NSE at 24 h (p = .82) and at 48 h (p = .23). Conclusion Concentrations of UCH‐L1 in serum were higher in patients with unfavourable outcome than in those with favourable outcome. However, the ability of UCH‐L1 to predict unfavourable outcome after OHCA was only moderate and not superior to that of NSE.

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Fluid Biomarkers for Monitoring Structural Changes in Polyneuropathies: Their Use in Clinical Practice and Trials

et al. 2021

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Reliable and responsive tools for monitoring disease activity and treatment outcomes in patients with neuropathies are lacking. With the emergence of ultrasensitive blood bioassays, proteins released with nerve damage are potentially useful response biomarkers for many neurological disorders, including polyneuropathies. In this review, we provide an overview of the existing literature focusing on potential applications in polyneuropathy clinical care and trials. Whilst several promising candidates have been identified, no studies have investigated if any of these proteins can serve as response biomarkers of longitudinal disease activity, except for neurofilament light (NfL). For NfL, limited evidence exists supporting a role as a response biomarker in Guillain-Barré syndrome, vasculitic neuropathy, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Most evidence exists for NfL as a response biomarker in hereditary transthyretin-related amyloidosis (hATTR). At the present time, the role of NfL is therefore limited to a supporting clinical tool or exploratory endpoint in trials. Future developments will need to focus on the discovery of additional biomarkers for anatomically specific and other forms of nerve damage using high-throughput technologies and highly sensitive analytical platforms in adequality powered studies of appropriate design. For NfL, a better understanding of cut-off values, the relation to clinical symptoms and long-term disability as well as dynamics in serum on and off treatment is needed to further expand and proceed towards implementation.

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Ultra-early serum concentrations of neuronal and astroglial biomarkers predict poor neurological outcome after out-of-hospital cardiac arrest—a pilot neuroprognostic study

Cited by 8 publications

References 35 publications

Serum neurofilament light chain as a predictive marker of neurologic outcome after cardiac arrest: a meta-analysis

Serum neurofilament light chain as a predictive marker of neurologic outcome after cardiac arrest: a meta-analysis

Ubiquitin C‐terminal hydrolase L1 after out‐of‐hospital cardiac arrest

Fluid Biomarkers for Monitoring Structural Changes in Polyneuropathies: Their Use in Clinical Practice and Trials

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