Plasma neurofilament light chain: A biomarker predicting severity in patients with acute ischemic stroke

Abstract

Neurofilament light chain (NfL) levels have proved to be a good biomarker in cerebrospinal fluid (CSF) correlating with the degree of neuronal injury and neurodegeneration. However, little is known about the value of plasma neurofilament light chain (pNfL) levels in predicting the clinical prognosis of patients with acute cerebral infarction. This study aimed to explore whether pNfL could be used as a biomarker to predict the severity of the outcomes of acute ischemic stroke (AIS). Patients with AIS were included from the Department of Neurology of the First People’s Hospital of Bengbu City from January 2018 to May 2019, as well as health control (HC). The plasma levels of NfL in patients with AIS (n = 60) at 2 days, 7 days, and 6 months after stroke, as well as in HCs (n = 60) were measured by electrochemiluminescence immunoassay(ECL) on the Meso Scale Discovery platform. Stroke severity was analyzed at admission using the National Institutes of Health Stroke Scale score. Functional outcomes were assessed at different times using the modified Rankin Scale (mRS) and Barthel Index. The mean level of pNfL in patients with ischemic stroke (IS) at 2 days (225.86 pg/L) after stroke was significantly higher than that in HC (107.02 pg/L) and gradually increased 7 days after stroke (316.23 pg/L) ( P < .0001). The mean level of pNfL in patients with IS at 6 months after stroke was 173.38 pg/L, which was still significantly higher than that of HC. The levels of pNfL at 7 days after stroke independently predicted modified Rankin Scale scores (mRS) ( R = 0.621, P < .001), Barthel Index ( R = –0.716, P < .001), and National Institutes of Health Stroke Scale ( R = –0.736, P < .001). The diagnostic severity and prognosis were evaluated by ROC curve, an area under the receiver operator curve of 0.812 ( P = .001, 95% CI: 0.69–0.93) at 7 days. Plasma NfL levels reflect neuronal injury after AIS. It changes with time and has a certain relationship with prognosis and may be a promising biomarker for predicting the severity of neuroaxonal injury in patients with acute IS.

Spectral exponent assessment and neurofilament light chain: a comprehensive approach to describe recovery patterns in stroke

“…Our results on NfL show a clear and univocal reduction over time, supporting the evidence that NfL can be a marker of lesion evolution during the post-acute stroke phase. This was already proposed but-to the best of our knowledge-previous literature lacked paired longitudinal controls or did not find a clear and univocal NfL reduction over time (18,(30)(31)(32). Additionally, we further confirmed the relationship between lesion volume and plasmatic NfL levels, already suggested by other authors (18,33).…”

Blood protein levels predict leading incident diseases and mortality in UK Biobank

“…Similarly, increased levels of neurofilament light (NEFL) were associated with higher incidence of multiple neurological traits (Parkinson's disease, Alzheimer's dementia, multiple sclerosis, amyotrophic lateral sclerosis and ischaemic stroke). These diseases are hallmarked by neuron degradation and NEFL may therefore be a consequential marker that is released into the blood upon breakdown of synapses 38,39 . R-spondin-1 (RSPO1) -the most significant association for endometriosis -is a regulator of endometrial mesenchymal stem-like cells during menstruation 40 .…”

Blood-Based Biomarkers for Neuroprognostication in Acute Brain Injury

“…An optimal cutoff level could not be obtained. 62 Other studies not included in the meta-analysis also produced concordant results that NfL levels, 60,[63][64][65][66] or even the rate of change in NfL levels early on, 67 may predict clinical outcomes and/or infarct volume. Serum NfL levels also correlate with cognitive outcomes, with prognostication strengthened by the addition of infarct and volume.…”