383 Neurofilament Light Chain as a Marker for Cerebral Anoxia in Out-of-Hospital Cardiac Arrest

Abstract Background: Out of hospital cardiac arrest (OHCA) is a life-threatening event. Continuous advances in management increased initial survival, but the rate of favorable neurological outcome remains low. We have previously shown the usefulness of proteomics to identify novel biomarkers to predict this outcome. Neurofilament light chain (NfL), a marker of axonal damage, has since emerged as a promising single marker. The aim of this study was thus to assess the predictive value of NfL and compare it to our established model.Methods: NfL was measured in plasma samples from OHCA drawn at 48 hours after the event using single molecule assays. Neurological function at discharge from ICU was recorded on the cerebral performance category (CPC) scale. Predictive ability was assessed for NfL and compared to an established multimarker model.Results: Seventy patients were included into this analysis, of whom 21 (30%) showed a favorable outcome (CPC 1-2) compared to 49 (70%) with an unfavorable outcome (CPC 3 - 5). NfL increased from CPC 1 to 5 (16.5 pg/ml to 641 pg/ml, p<0.001). NfL alone performed moderately well with an area under the ROC (AUROC) of 79.4%. Prediction was significantly improved by combination of NfL with the established best performing model (F = 6.83, p = 0.01) with an AUROC to 89.7% (p for comparison = 0.017).Conclusion:The combination of NfL with other plasma and clinical markers is superior to that of either model alone and achieves a very good AUROC in this relatively small sample. Trial registration: ClinicalTrials.gov NCT01960699. Registered 08 October 2013.

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Serum Neurofilament Light Chain for Prognosis of Outcome After Cardiac Arrest

JAMA Neurology ◽

10.1001/jamaneurol.2018.3223 ◽

2019 ◽

Vol 76 (1) ◽

pp. 64 ◽

Cited By ~ 47

Author(s):

Marion Moseby-Knappe ◽

Niklas Mattsson ◽

Niklas Nielsen ◽

Henrik Zetterberg ◽

Kaj Blennow ◽

...

Keyword(s):

Cardiac Arrest ◽

Light Chain ◽

Neurofilament Light Chain ◽

Neurofilament Light

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Neurofilament light chain as an early and sensitive predictor of long-term neurological outcome in patients after cardiac arrest

International Journal of Cardiology ◽

10.1016/j.ijcard.2012.12.016 ◽

2013 ◽

Vol 168 (2) ◽

pp. 1322-1327 ◽

Cited By ~ 19

Author(s):

Obaida R. Rana ◽

Jörg W. Schröder ◽

Julia K. Baukloh ◽

Esra Saygili ◽

Karl Mischke ◽

...

Keyword(s):

Cardiac Arrest ◽

Light Chain ◽

Neurological Outcome ◽

Neurofilament Light Chain ◽

Neurofilament Light

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The accuracy of various neuro-prognostication algorithms and the added value of neurofilament light chain dosage for patients resuscitated from shockable cardiac arrest: an ancillary analysis of the ISOCRATE study

Resuscitation ◽

10.1016/j.resuscitation.2021.12.009 ◽

2021 ◽

Author(s):

Caroline Pouplet ◽

Gwenhael Colin ◽

Elie Guichard ◽

Jean Reignier ◽

Amélie Le Gouge ◽

...

Keyword(s):

Cardiac Arrest ◽

Light Chain ◽

Added Value ◽

Neurofilament Light Chain ◽

Neurofilament Light

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Prediction of Neurological Recovery After Cardiac Arrest Using Neurofilament Light Chain is Improved by a Proteomics-Based Multimarker Panel

Neurocritical Care ◽

10.1007/s12028-021-01321-1 ◽

2021 ◽

Author(s):

Raphael Wurm ◽

Henrike Arfsten ◽

Besnik Muqaku ◽

Markus Ponleitner ◽

Andrea Bileck ◽

...

Keyword(s):

Cardiac Arrest ◽

Light Chain ◽

Neurological Recovery ◽

Neurofilament Light Chain ◽

Neurofilament Light

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Absolute serum neurofilament light chain levels and its early kinetics predict brain injury after out-of-hospital cardiac arrest

Journal of Neurology ◽

10.1007/s00415-021-10722-3 ◽

2021 ◽

Author(s):

Christoph Adler ◽

Oezguer A. Onur ◽

Simon Braumann ◽

Hannes Gramespacher ◽

Stefan Bittner ◽

...

Keyword(s):

Cardiac Arrest ◽

Brain Injury ◽

High Sensitivity ◽

Published Data ◽

Serum Samples ◽

Neurofilament Light Chain ◽

Neurofilament Light ◽

Poor Outcome ◽

Kinetics Of ◽

Hospital Cardiac Arrest

Abstract Objectives To test if the early kinetics of neurofilament light (NFL) in blood adds to the absolute values of NFL in the prediction of outcome, and to evaluate if NFL can discriminate individuals with severe hypoxic–ischemic brain injury (sHIBI) from those with other causes of poor outcome after out-of-hospital cardiac arrest (OHCA). Design and setting Monocentric retrospective study involving individuals following non-traumatic OHCA between April 2014 and April 2016. NFL concentrations were determined on a SiMoA HD-1 device using NF-Light Advantage Kits. Participants Of 73 patients screened, 53 had serum samples available for NFL measurement at three timepoints (after 3, 24, and 48 h of admission). Of these 53 individuals, 43.4% had poor neurologic outcome at discharge as assessed by Glasgow–Pittsburgh cerebral performance categories, and, according to a current prognostication algorithm, poor outcome due to sHIBI in 20.7%. Main outcome measure Blood NFL and its early kinetics for prognostication of outcome and prediction of sHIBI after OHCA. Results An absolute NFL > 508.6 pg/ml 48 h after admission, or a change in NFL > 494 pg/ml compared with an early baseline value predicted outcome, and discriminated severe sHIBI from other causes of unfavorable outcome after OHCA with high sensitivity (100%, 95%CI 70.0–100%) and specificity (91.7%, 95%CI 62.5–100%). Conclusions Not only absolute values of NFL, but also early changes in NFL predict the outcome following OHCA, and may differentiate sHIBI from other causes of poor outcome after OHCA with high sensitivity and specificity. Our study adds to published data, overall corroborating that NFL measured in blood should be implemented in prognostication algorithms used in clinical routine.

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