血清神经丝蛋白测量可改善心脏骤停后结局预测的临床风险评分：一项前瞻性研究的结果。
Serum neurofilament measurement improves clinical risk scores for outcome prediction after cardiac arrest: results of a prospective study.
机构信息
Intensive Care Unit, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland.
出版信息
Crit Care. 2021 Jan 20;25(1):32. doi: 10.1186/s13054-021-03459-y.
BACKGROUND
A recent study found serum neurofilament light chain (NfL) levels to be strongly associated with poor neurological outcome in patients after cardiac arrest. Our aim was to confirm these findings in an independent validation study and to investigate whether NfL improves the prognostic value of two cardiac arrest-specific risk scores.
METHODS
This prospective, single-center study included 164 consecutive adult after out-of-hospital cardiac arrest (OHCA) patients upon intensive care unit admission. We calculated two clinical risk scores (OHCA, CAHP) and measured NfL on admission within the first 24 h using the single molecule array NF-light assay. The primary endpoint was neurological outcome at hospital discharge assessed with the cerebral performance category (CPC) score.
RESULTS
Poor neurological outcome (CPC > 3) was found in 60% (98/164) of patients, with 55% (91/164) dying within 30 days of hospitalization. Compared to patients with favorable outcome, NfL was 14-times higher in patients with poor neurological outcome (685 ± 1787 vs. 49 ± 111 pg/mL), with an adjusted odds ratio of 3.4 (95% CI 2.1 to 5.6, p < 0.001) and an area under the curve (AUC) of 0.82. Adding NfL to the clinical risk scores significantly improved discrimination of both the OHCA score (from AUC 0.82 to 0.89, p < 0.001) and CAHP score (from AUC 0.89 to 0.92, p < 0.05). Adding NfL to both scores also resulted in significant improvement in reclassification statistics with a Net Reclassification Index (NRI) of 0.58 (p < 0.001) for OHCA and 0.83 (p < 0.001) for CAHP.
CONCLUSIONS
Admission NfL was a strong outcome predictor and significantly improved two clinical risk scores regarding prognostication of neurological outcome in patients after cardiac arrest. When confirmed in future outcome studies, admission NfL should be considered as a standard laboratory measures in the evaluation of OHCA patients.
背景
最近的一项研究发现，血清神经丝轻链（NfL）水平与心脏骤停后患者的不良神经结局密切相关。我们的目的是在一项独立验证研究中证实这些发现，并研究 NfL 是否能提高两种心脏骤停特异性风险评分的预后价值。
方法
这项前瞻性、单中心研究纳入了重症监护病房收治的 164 例连续成年院外心脏骤停（OHCA）患者。我们在入院后 24 小时内计算了两个临床风险评分（OHCA、CAHP），并使用单分子阵列 NF-light 测定法测量了 NfL。主要终点是出院时的神经功能结局，使用脑功能分类（CPC）评分评估。
结果
60%（98/164）的患者神经功能结局不良（CPC>3），55%（91/164）在住院后 30 天内死亡。与预后良好的患者相比，神经功能不良的患者 NfL 水平高 14 倍（685±1787 vs. 49±111pg/mL），调整后的优势比为 3.4（95%CI 2.1-5.6，p<0.001），曲线下面积（AUC）为 0.82。将 NfL 加入临床风险评分显著提高了 OHCA 评分（从 AUC 0.82 到 0.89，p<0.001）和 CAHP 评分（从 AUC 0.89 到 0.92，p<0.05）的区分度。将 NfL 添加到两个评分中还显著改善了重新分类统计，OHCA 的净重新分类指数（NRI）为 0.58（p<0.001），CAHP 的 NRI 为 0.83（p<0.001）。
结论
入院时的 NfL 是一个强有力的结局预测指标，显著提高了两种临床风险评分在心脏骤停后患者神经结局预测方面的预后价值。如果在未来的结局研究中得到证实，入院时的 NfL 应该被视为评估 OHCA 患者的标准实验室指标。
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