Department of Neurology, Medical University of Vienna, Vienna, Austria.
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Neurocrit Care. 2022 Apr;36(2):434-440. doi: 10.1007/s12028-021-01321-1. Epub 2021 Aug 3.
Continuous advances in resuscitation care have increased survival, but the rate of favorable neurological outcome remains low. We have shown the usefulness of proteomics in identifying novel biomarkers to predict neurological outcome. Neurofilament light chain (NfL), a marker of axonal damage, has since emerged as a promising single marker. The aim of this study was to assess the predictive value of NfL in comparison with and in addition to our established model.
NfL was measured in plasma samples drawn at 48 h after cardiac arrest using single-molecule assays. Neurological function was recorded on the cerebral performance category (CPC) scale at discharge from the intensive care unit and after 6 months. The ability to predict a dichotomized outcome (CPC 1-2 vs. 3-5) was assessed with receiver operating characteristic (ROC) curves.
Seventy patients were included in this analysis, of whom 21 (30%) showed a favorable outcome (CPC 1-2), compared with 49 (70%) with an unfavorable outcome (CPC 3-5) at discharge. NfL increased from CPC 1 to 5 (16.5 pg/ml to 641 pg/ml, p < 0.001). The addition of NfL to the existing model improved it significantly (Wald test, p < 0.001), and the combination of NfL with a multimarker model showed high areas under the ROC curve (89.7% [95% confidence interval 81.7-97.7] at discharge and 93.7% [88.2-99.2] at 6 months) that were significantly greater than each model alone.
The combination of NfL with other plasma and clinical markers is superior to that of either model alone and achieves high areas under the ROC curve in this relatively small sample.
复苏护理的不断进步提高了生存率，但神经功能良好的预后率仍然较低。我们已经证明了蛋白质组学在识别预测神经预后的新生物标志物方面的有用性。神经丝轻链（NfL），一种轴突损伤的标志物，已成为一种很有前途的单一标志物。本研究旨在评估 NfL 的预测价值，并与我们建立的模型进行比较。
使用单分子检测法在心脏骤停后 48 小时采集血浆样本，测量 NfL。在重症监护病房出院和 6 个月后，使用脑功能分类（CPC）量表记录神经功能。使用接收者操作特征（ROC）曲线评估预测二分类结局（CPC 1-2 与 3-5）的能力。
本分析共纳入 70 例患者，其中 21 例（30%）出院时预后良好（CPC 1-2），49 例（70%）预后不良（CPC 3-5）。NfL 从 CPC 1 增加到 5（16.5 pg/ml 增加到 641 pg/ml，p < 0.001）。将 NfL 添加到现有模型中可显著改善模型（Wald 检验，p < 0.001），且 NfL 与多标志物模型相结合的 ROC 曲线下面积较高（出院时为 89.7% [95%置信区间 81.7-97.7]，6 个月时为 93.7% [88.2-99.2]），显著高于各模型单独使用时的 AUC。
NfL 与其他血浆和临床标志物的联合使用优于各模型单独使用，在这个相对较小的样本中，ROC 曲线下面积较高。
