Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland.
Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
Epilepsy Behav. 2019 Dec;101(Pt B):106432. doi: 10.1016/j.yebeh.2019.07.033. Epub 2019 Jul 30.
Functional outcome in patients with postanoxic encephalopathy after cardiac arrest (CA) often remains unclear, and there is a strong need of new prognostication measures. We aimed at investigating serum neurofilament light (NfL) chain concentration in patients with a postanoxic encephalopathy after CA and its prognostic potential. Serum samples were prospectively collected at different time points after CA in consecutive patients admitted to the intensive care unit (ICU) of Ticino Cardiocentre (Lugano, Switzerland) between June 2017 and March 2018. Serum NfL concentration was measured using a single molecule array (SIMOA) assay. The association of NfL levels with time to return of spontaneous circulation (ROSC), serum neuronal specific enolase (NSE) concentration, time between CA and sample collection, electroencephalogram (EEG) pattern and clinical outcome (death status at one month) were explored. Fourteen patients experiencing 15 CAs were included in the study (median age = 58 (57-68) years, 8 males). Median serum NfL concentration was 1027.0 (25.5-6033.7) pg/ml. There were positive associations between serum NfL and time to ROSC (rho = 0.60, p < 0.0001), NSE concentration (rho = 0.76, p < 0.0001), and severity of brain damage as estimated by EEG, with the highest concentrations measured in patients with suppressed electrical activity (14,954.0 [9006.0-25,364.0] pg/ml). Neurofilament light concentration remained high in samples collected up to 17 days after CA. Median NfL levels were higher among dead than alive patients at one month (6401.7 [3768.5-15,573.3] vs 25.5 [25.2-75.4] pg/ml). High NfL levels performed better than NSE in predicting death status at one month (NfL area under the curve (AUC) = 0.98, 95% confidence interval (CI) = 0.94-1.00; NSE AUC = 0.80, 95% CI = 0.67-0.94). These results support the potential inclusion of serum NfL in the battery of prognostication measures to be used in patients with postanoxic encephalopathy in ICU settings. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
在心脏骤停（CA）后发生缺氧性脑病的患者中，其功能预后通常仍不清楚，因此急需新的预后评估方法。本研究旨在探讨 CA 后缺氧性脑病患者血清神经丝轻链（NfL）浓度及其预后价值。连续纳入 2017 年 6 月至 2018 年 3 月期间入住瑞士提契诺心脏中心（卢加诺）重症监护病房（ICU）的 CA 患者，在 CA 后不同时间点前瞻性采集血清样本。采用单分子阵列（SIMOA）法测定血清 NfL 浓度。探讨 NfL 水平与自主循环恢复（ROSC）时间、血清神经元特异性烯醇化酶（NSE）浓度、CA 与样本采集时间间隔、脑电图（EEG）模式和临床结局（1 个月时的死亡状态）之间的相关性。研究共纳入 14 例经历 15 次 CA 的患者（中位年龄 58（57-68）岁，8 名男性）。中位血清 NfL 浓度为 1027.0（25.5-6033.7）pg/ml。血清 NfL 与 ROSC 时间（rho=0.60，p<0.0001）、NSE 浓度（rho=0.76，p<0.0001）呈正相关，与 EEG 估计的脑损伤严重程度呈正相关，其中电活动抑制患者的浓度最高（14954.0[9006.0-25364.0]pg/ml）。CA 后 17 天内采集的样本中，NfL 浓度仍保持较高水平。1 个月时死亡患者的中位 NfL 水平高于存活患者（6401.7[3768.5-15573.3]vs 25.5[25.2-75.4]pg/ml）。与 NSE 相比，高 NfL 水平在预测 1 个月时的死亡状态方面表现更好（NfL 曲线下面积（AUC）=0.98，95%置信区间（CI）=0.94-1.00；NSE AUC=0.80，95%CI=0.67-0.94）。这些结果支持将血清 NfL 纳入 ICU 中缺氧性脑病患者预后评估方法中。本文是“第七届伦敦-因斯布鲁克癫痫持续状态和急性发作学术研讨会”特刊的一部分。
