Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest
(2023) In Critical Care 27(1).- 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... (More)
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.
(Less)
- author
- organization
-
- Center for cardiac arrest (research group)
- Intensive Care Epidemiology (research group)
- Anesthesiology and Intensive Care
- Brain Injury After Cardiac Arrest (research group)
- Neurology, Lund
- Clinical Sciences, Helsingborg
- SWECRIT (research group)
- Clinical Memory Research (research group)
- WCMM-Wallenberg Centre for Molecular Medicine
- MultiPark: Multidisciplinary research focused on Parkinson´s disease
- LU Profile Area: Proactive Ageing
- publishing date
- 2023-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Biomarker, In-hospital cardiac arrest (IHCA), Neurofilament light (NfL), Out-of-hospital cardiac arrest (OHCA), Prognostication
- in
- Critical Care
- volume
- 27
- issue
- 1
- article number
- 74
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85148965172
- pmid:36829239
- ISSN
- 1364-8535
- DOI
- 10.1186/s13054-023-04355-3
- project
- SweCrit, a critical care biobank
- language
- English
- LU publication?
- yes
- id
- be4d15b3-3838-4223-ab2b-242cb1e104a9
- date added to LUP
- 2023-03-15 16:25:59
- date last changed
- 2024-09-18 17:44:04
@article{be4d15b3-3838-4223-ab2b-242cb1e104a9, abstract = {{<p>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.</p>}}, author = {{Levin, Helena and Lybeck, Anna and Frigyesi, Attila and Arctaedius, Isabelle and Thorgeirsdóttir, Bergthóra and Annborn, Martin and Moseby-Knappe, Marion and Nielsen, Niklas and Cronberg, Tobias and Ashton, Nicholas J. and Zetterberg, Henrik and Blennow, Kaj and Friberg, Hans and Mattsson-Carlgren, Niklas}}, issn = {{1364-8535}}, keywords = {{Biomarker; In-hospital cardiac arrest (IHCA); Neurofilament light (NfL); Out-of-hospital cardiac arrest (OHCA); Prognostication}}, language = {{eng}}, number = {{1}}, publisher = {{BioMed Central (BMC)}}, series = {{Critical Care}}, title = {{Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest}}, url = {{http://dx.doi.org/10.1186/s13054-023-04355-3}}, doi = {{10.1186/s13054-023-04355-3}}, volume = {{27}}, year = {{2023}}, }