Blood neurofilament light concentration at admittance: a potential prognostic marker in COVID-19

Abstract

Objective To test the hypotheses that blood biomarkers for nervous system injury, serum concentrations of neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAp) can serve as biomarkers for disease severity in COVID-19 patients. Methods Forty-seven inpatients with confirmed COVID-19 had blood samples drawn on admission for assessing serum biomarkers of CNS injury by Single molecule array (Simoa), NfL and GFAp. Concentrations of NfL and GFAp were analyzed in relation to symptoms, clinical signs, inflammatory biomarkers and clinical outcomes. We used multivariate linear models to test for differences in biomarker concentrations in the subgroups, accounting for confounding effects. Results In total, 21% (n = 10) of the patients were admitted to an intensive care unit, and the overall mortality rate was 13% (n = 6). Non-survivors had higher serum concentrations of NfL (p < 0.001) upon admission than patients who were discharged alive both in adjusted analyses (p = 2.6 × 10–7) and unadjusted analyses (p = 0.001). The concentrations of NfL in non-survivors increased over repeated measurements; whereas, the concentrations in survivors were stable. The GFAp concentration was also significantly higher in non-survivors than survivors (p = 0.02). Conclusion Increased concentrations of NfL and GFAp in COVID-19 patients on admission may indicate increased mortality risk. Measurement of blood biomarkers for nervous system injury can be useful to detect and monitor CNS injury in COVID-19.

Tetravalent Influenza Vaccine Is Not Associated With Neuroaxonal Damage in Multiple Sclerosis Patients

“…In fact, recent studies revealed elevated NfL levels during COVID-19, irrespective of the clinical course (32,33). Moreover, increased NfL concentrations at the time of admission of COVID-19 patients were linked to a higher mortality risk (34). This is of interest as SARS-CoV-2 primarily affects the respiratory system, and a direct impact on neurons has not ultimately been clarified (35)(36)(37).…”

Cognitive symptoms after COVID-19

“…Some authors have found that patients with COVID-19 admitted to the ICU show elevated levels of glial fibrillary acidic protein and neurofilament light protein (NfL) in the blood, ( 44 , 45 ) and that high NfL levels are associated with poorer prognosis. ( 44 , 46 , 47 ) A recent study including 142 hospitalised patients found that even patients with no neurological symptoms presented high NfL levels, and that high levels were associated with poor outcomes. ( 47 ) Another study reported elevated plasma levels of IL-4 and markers of neuronal damage in neuronal-enriched extracellular vesicles in patients with neurological symptoms.…”

Neurological Manifestations Associated with SARS-CoV-2 Invasion of the Autonomous Nervous System

“…Neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAp) in COVID-19 patients on admission correlates with increased mortality risk [27]. A study on 47 mild, moderate and severe COVID-19 revealed that patients with severe COVID-19 exhibited higher plasma concentrations of GFAp and NfL than controls, while GFAp was also increased in patients with moderate disease [28].…”