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

Abstract

Background Previous studies have reported high prognostic accuracy of circulating neurofilament light (NfL) at 24–72 h after out-of-hospital cardiac arrest (OHCA), but performance at earlier time points and after in-hospital cardiac arrest (IHCA) is less investigated. We aimed to assess plasma NfL during the first 48 h after OHCA and IHCA to predict long-term outcomes. Methods Observational multicentre cohort study in adults admitted to intensive care after cardiac arrest. NfL was retrospectively analysed in plasma collected on admission to intensive care, 12 and 48 h after cardiac arrest. The outcome was assessed at two to six months using the Cerebral Performance Category (CPC) scale, where CPC 1–2 was considered a good outcome and CPC 3–5 a poor outcome. Predictive performance was measured with the area under the receiver operating characteristic curve (AUROC). Results Of 428 patients, 328 (77%) suffered OHCA and 100 (23%) IHCA. Poor outcome was found in 68% of OHCA and 55% of IHCA patients. The overall prognostic performance of NfL was excellent at 12 and 48 h after OHCA, with AUROCs of 0.93 and 0.97, respectively. The predictive ability was lower after IHCA than OHCA at 12 and 48 h, with AUROCs of 0.81 and 0.86 (p ≤ 0.03). AUROCs on admission were 0.77 and 0.67 after OHCA and IHCA, respectively. At 12 and 48 h after OHCA, high NfL levels predicted poor outcome at 95% specificity with 70 and 89% sensitivity, while low NfL levels predicted good outcome at 95% sensitivity with 71 and 74% specificity and negative predictive values of 86 and 88%. Conclusions The prognostic accuracy of NfL for predicting good and poor outcomes is excellent as early as 12 h after OHCA. NfL is less reliable for the prediction of outcome after IHCA.

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

“…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.…”

“…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 …”

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

“…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 ].…”

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?*

“…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).…”

“…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).…”