Increased serum neurofilament light chain concentration indicates poor outcome in Guillain-Barré syndrome

Abstract

Background: Guillain-Barré syndrome (GBS) is an autoimmune disease that results in demyelination and axonal damage. Five percent of patients die and 20% remain significantly disabled on recovery. Recovery is slow in most cases and eventual disability is difficult to predict, especially early in the disease. Blood or cerebrospinal fluid (CSF) biomarkers that could help identify patients at risk of poor outcome are required. We measured serum neurofilament light chain (sNfL) concentrations from blood taken upon admission and investigated a correlation between sNfL and clinical outcome. Methods: Baseline sNfL levels in 27 GBS patients were compared with a control group of 22 patients with diagnoses not suggestive of any axonal damage. Clinical outcome parameters for GBS patients included (i) the Hughes Functional Score (HFS) at admission, nadir, and discharge; (ii) the number of days hospitalised; and (iii) whether intensive care was necessary. Results: The median sNfL concentration in our GBS sample on admission was 85.5 pg/ml versus 9.1 pg/ml in controls. A twofold increase in sNfL concentration at baseline was associated with an HFS increase of 0.6 at nadir and reduced the likelihood of discharge with favourable outcome by a factor of almost three. Higher sNfL levels upon admission correlated well with hospitalisation time (r s = 0.69, p < 0.0001), during which transfer to intensive care occurred more frequently at an odds ratio of 2.4. Patients with baseline sNfL levels below 85.5 pg/ml had a 93% chance of being discharged with an unimpaired walking ability. Conclusions: sNfL levels measured at hospital admission correlated with clinical outcome in GBS patients. These results represent amounts of acute axonal damage and reflect mechanisms resulting in disability in GBS. Thus, sNfL may serve as a convenient blood-borne biomarker to personalise patient care by identifying those at higher risk of poor outcome.

Prognostic value of neurofilament light chain in chronic inflammatory demyelinating polyneuropathy

“…Median sNfL levels in our cohort were measured to be 28.3 pg/ml, showing a mild increase in comparison to previously published sNfL levels of healthy and non-neurodegenerative controls (<10 pg/ml) 38 , 39 while demonstrating similarity to a previously reported median of 27.2 pg/ml in 24 patients with CIDP receiving immunomodulatory therapy at time of sampling. 19 We demonstrated that sNfL levels were associated with 1-year disease progression, which was in contrast to van Lieverloo et al 19 who did not observe associations between sNfL and change in impairment in patients in whom therapy was initiated at start of study.…”

Miller‐Fisher syndrome after COVID‐19: neurochemical markers as an early sign of nervous system involvement

“…With the spreading of the SARS-CoV-2 pandemic worldwide, more such cases will probably be described. Measurement of NfL in the blood might be considered an easy tool to detect early affection of the peripheral and central nervous system [6,7].…”

Serum Neurofilament Light Chain Measurement in MS: Hurdles to Clinical Translation

“…Extensively reviewed elsewhere ( Khalil et al, 2018 ; Barro et al, 2020 ), higher sNfL is seen in many central and peripheral nervous system diseases that involve neuroaxonal injury including neurodegenerative conditions ( Forgrave et al, 2019 ), stroke ( Nielsen et al, 2020 - plasma concentrations), and peripheral neuropathies ( Altmann et al, 2020 ). Analogous to troponin in cardiac disease, clinical context is required.…”