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

Levin, Helena LU ; Lybeck, Anna LU orcid ; Frigyesi, Attila LU ; Arctaedius, Isabelle LU ; Thorgeirsdóttir, Bergthóra LU orcid ; Annborn, Martin LU ; Moseby-Knappe, Marion LU ; Nielsen, Niklas LU ; Cronberg, Tobias LU and Ashton, Nicholas J. , et al. (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.

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publishing date
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
  • pmid:36829239
  • scopus:85148965172
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
2024-07-10 10:05:34
@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}},
}