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 pla...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-02-01
|
| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04355-3 |
| _version_ | 1797864591080816640 |
|---|---|
| author | Helena Levin Anna Lybeck Attila Frigyesi Isabelle Arctaedius Bergthóra Thorgeirsdóttir Martin Annborn Marion Moseby-Knappe Niklas Nielsen Tobias Cronberg Nicholas J. Ashton Henrik Zetterberg Kaj Blennow Hans Friberg Niklas Mattsson-Carlgren |
| author_facet | Helena Levin Anna Lybeck Attila Frigyesi Isabelle Arctaedius Bergthóra Thorgeirsdóttir Martin Annborn Marion Moseby-Knappe Niklas Nielsen Tobias Cronberg Nicholas J. Ashton Henrik Zetterberg Kaj Blennow Hans Friberg Niklas Mattsson-Carlgren |
| author_sort | Helena Levin |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T22:55:28Z |
| format | Article |
| id | doaj.art-d216a41665f94af3b0d978181f1cc538 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-09T22:55:28Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-d216a41665f94af3b0d978181f1cc5382023-03-22T11:21:15ZengBMCCritical Care1364-85352023-02-0127111010.1186/s13054-023-04355-3Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrestHelena Levin0Anna Lybeck1Attila Frigyesi2Isabelle Arctaedius3Bergthóra Thorgeirsdóttir4Martin Annborn5Marion Moseby-Knappe6Niklas Nielsen7Tobias Cronberg8Nicholas J. Ashton9Henrik Zetterberg10Kaj Blennow11Hans Friberg12Niklas Mattsson-Carlgren13Anesthesia & Intensive Care, Department of Clinical Sciences, Lund UniversityAnesthesia & Intensive Care, Department of Clinical Sciences, Skane University Hospital, Lund UniversityAnesthesia & Intensive Care, Department of Clinical Sciences, Skane University Hospital, Lund UniversityAnesthesia & Intensive Care, Department of Clinical Sciences, Skane University Hospital, Lund UniversityAnesthesia & Intensive Care, Department of Clinical Sciences, Skane University Hospital, Lund UniversityAnesthesia & Intensive Care, Department of Clinical Sciences, Helsingborg Hospital, Lund UniversityNeurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund UniversityAnesthesia & Intensive Care, Department of Clinical Sciences, Helsingborg Hospital, Lund UniversityNeurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund UniversityInstitute of Psychiatry, Psychology and Neuroscience, King’s College LondonDepartment of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of GothenburgDepartment of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of GothenburgAnesthesia & Intensive Care, Department of Clinical Sciences, Skane University Hospital, Lund UniversityClinical Memory Research Unit, Department of Clinical Sciences, Lund UniversityAbstract 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.https://doi.org/10.1186/s13054-023-04355-3Out-of-hospital cardiac arrest (OHCA)In-hospital cardiac arrest (IHCA)PrognosticationBiomarkerNeurofilament light (NfL) |
| spellingShingle | Helena Levin Anna Lybeck Attila Frigyesi Isabelle Arctaedius Bergthóra Thorgeirsdóttir Martin Annborn Marion Moseby-Knappe Niklas Nielsen Tobias Cronberg Nicholas J. Ashton Henrik Zetterberg Kaj Blennow Hans Friberg Niklas Mattsson-Carlgren Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest Critical Care Out-of-hospital cardiac arrest (OHCA) In-hospital cardiac arrest (IHCA) Prognostication Biomarker Neurofilament light (NfL) |
| title | Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest |
| title_full | Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest |
| title_fullStr | Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest |
| title_full_unstemmed | Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest |
| title_short | Plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest |
| title_sort | plasma neurofilament light is a predictor of neurological outcome 12 h after cardiac arrest |
| topic | Out-of-hospital cardiac arrest (OHCA) In-hospital cardiac arrest (IHCA) Prognostication Biomarker Neurofilament light (NfL) |
| url | https://doi.org/10.1186/s13054-023-04355-3 |
| work_keys_str_mv | AT helenalevin plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT annalybeck plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT attilafrigyesi plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT isabellearctaedius plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT bergthorathorgeirsdottir plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT martinannborn plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT marionmosebyknappe plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT niklasnielsen plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT tobiascronberg plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT nicholasjashton plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT henrikzetterberg plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT kajblennow plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT hansfriberg plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest AT niklasmattssoncarlgren plasmaneurofilamentlightisapredictorofneurologicaloutcome12haftercardiacarrest |