Serum neurofilament light chain predicts long-term prognosis in Guillain-Barré syndrome patients

Abstract

ObjectiveTo study baseline serum neurofilament light chain (sNfL) levels as a prognostic biomarker in Guillain-Barré syndrome (GBS).MethodsWe measured NfL in serum (98 samples) and cerebrospinal fluid (CSF) (24 samples) of patients with GBS prospectively included in the International GBS Outcome Study (IGOS) in Spain using single-molecule array (SiMoA) and compared them with 53 healthy controls (HCs). We performed multivariable regression to analyse the association between sNfL levels and functional outcome at 1 year.ResultsPatients with GBS had higher NfL levels than HC in serum (55.49 pg/mL vs 9.83 pg/mL, p<0.0001) and CSF (1308.5 pg/mL vs 440.24 pg/mL, p=0.034). Patients with preceding diarrhoea had higher sNfL than patients with respiratory symptoms or no preceding infection (134.90 pg/mL vs 47.86 pg/mL vs 38.02 pg/mL, p=0.016). sNfL levels correlated with Guillain-Barré Syndrome Disability Score and Inflammatory Rasch-built Overall Disability Scale (I-RODS) at every timepoint. Patients with pure motor variant and Miller Fisher syndrome showed higher sNfL levels than patients with sensorimotor GBS (162.18 pg/mL vs 95.50 pg/mL vs 38.02 pg/mL, p=0.025). Patients with acute motor axonal neuropathy cute motor axonal neuropathy had higher sNfL levels than other variants (190.55 pg/mL vs 46.79 pg/mL, p=0.013). sNfL returned to normal levels at 1 year. High baseline sNfL levels were associated with inability to run (OR=1.65, 95% CI 1.14 to 2.40, p=0.009) and lower I-RODS (β −2.60, 95% CI −4.66 to −0.54, p=0.014) at 1 year. Cut-off points predicting clinically relevant outcomes at 1 year with high specificity were calculated: inability to walk independently (>319 pg/mL), inability to run (>248 pg/mL) and ability to run (<34 pg/mL).ConclusionBaseline sNfL levels are increased in patients with GBS, are associated with disease severity and axonal variants and have an independent prognostic value in patients with GBS.

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.…”

Autoantibody screening in Guillain-Barré Syndrome

“…Although in this study we analysed the prognostic value of anti-ganglioside antibodies using the traditional outcome measures: inability to walk (GDS≥3) at 6 months and at 1 year, we have recently used the inability to run (GDS≥2). In this recent study we showed that high baseline sNfL were independently associated with inability to run at 1 year 21 . In agreement with these findings, we observed that including in the model the variable "presence of serum IgG anti-GM1 antibodies", sNfL levels remained as an independent prognostic factor, whereas anti-GM1 antibodies did not.…”

“…Finally, when we included the presence of anti-GM1 antibodies in our previously reported prognostic study 21 , we observed that having anti-GM1 IgG antibodies at All rights reserved. No reuse allowed without permission.…”

Review article on COVID-19 and Guillain-Barré syndrome

“…The last variant is AMAN (Acute Motor Axonal Neuropathy), which is distinguished from Acute inflammatory Demyelinating Polyneuropathy by its selective involvement of motor nerves and by electrophysiologic pattern of axonal involvement [10,11].…”