Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark, Phone: +45 78455252.
Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
Clin Chem Lab Med. 2020 Jan 28;58(2):261-267. doi: 10.1515/cclm-2019-0532.
Background Neurofilament light chain (NfL) is a neuron-specific biomarker with prognostic ability in several types of central nervous system injuries. This study investigates if plasma NfL (pNfL) is elevated early after spontaneous intracerebral hemorrhage (ICH) and whether such elevation reflects disease severity and day-30 outcome. Methods pNfL was quantified by single molecule array analysis in 103 reference subjects (RS) and in samples from 37 patients with ICH obtained on admission to hospital and at 24-h follow-up. The primary outcome was day-30 mortality. Clinical status on admission was evaluated by standardized scoring systems. Results Median pNfL among RS was 9.6 (interquartile range [IQR] 6.2) pg/mL. Upon admission, ICH patients had pNfL of 19.8 (IQR 30.7) pg/mL increasing to 35.9 (IQR 44.5) pg/mL at 24 h (all, p < 0.001). On admission, pNfL was higher among ICH non-survivors than survivors (119.2 [IQR 152.6] pg/mL vs. 15.7 [IQR 19.6] pg/mL, p < 0.01) and this difference was observed also on 24 h follow-up (195.1 [IQR 73.9] pg/mL vs. 31.3 [IQR 27.8] pg/mL, p < 0.01). The area under the receiver operating characteristic curve (ROC AUC) for discrimination of day-30 mortality was significant on admission (AUC = 0.83, 95% confidence interval [CI]: 0.56-1.0) and increased on 24-h follow-up (AUC = 0.93, 95% CI: 0.84-1.0). The odds ratio (OR) for death, by each quartile increase in pNfL was significant both on admission (OR = 4.52, 95% CI: 1.32-15.48) and after 24-h follow-up (OR = 9.52, 95% CI: 1.26-71.74). Conclusions PNfL is associated with day-30 mortality after spontaneous ICH when early after the ictus.
背景 神经丝轻链（NfL）是一种具有预后能力的神经元特异性生物标志物，存在于多种中枢神经系统损伤中。本研究旨在探讨自发性脑出血（ICH）后早期血浆 NfL（pNfL）是否升高，以及这种升高是否反映疾病严重程度和 30 天结局。
方法 通过单分子阵列分析，在 103 名参考对象（RS）和 37 名 ICH 患者的样本中定量检测 pNfL，这些样本分别在入院时和 24 小时随访时获得。主要结局是 30 天死亡率。入院时的临床状态采用标准化评分系统进行评估。
结果 RS 中 pNfL 的中位数为 9.6（四分位距[IQR]6.2）pg/mL。ICH 患者入院时 pNfL 为 19.8（IQR 30.7）pg/mL，24 小时时升高至 35.9（IQR 44.5）pg/mL（均，p<0.001）。入院时，ICH 幸存者的 pNfL 高于非幸存者（119.2[IQR 152.6]pg/mL 比 15.7[IQR 19.6]pg/mL，p<0.01），24 小时随访时也观察到这种差异（195.1[IQR 73.9]pg/mL 比 31.3[IQR 27.8]pg/mL，p<0.01）。入院时区分 30 天死亡率的受试者工作特征曲线（ROC AUC）有显著意义（AUC=0.83，95%置信区间[CI]：0.56-1.0），24 小时随访时增加（AUC=0.93，95%CI：0.84-1.0）。入院时，pNfL 每增加一个四分位数，死亡的优势比（OR）均有显著意义（OR=4.52，95%CI：1.32-15.48），24 小时后随访时也有显著意义（OR=9.52，95%CI：1.26-71.74）。
结论 在 ICH 后早期，pNfL 与自发性 ICH 后 30 天死亡率相关。
