Anesthesia & Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden.
Department of Research & Education, Skane University Hospital, Lund, Sweden.
Crit Care. 2023 Feb 24;27(1):74. doi: 10.1186/s13054-023-04355-3.
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.
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).
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%.
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.
先前的研究报告称，在院外心脏骤停（OHCA）后 24-72 小时，循环神经丝轻链（NfL）具有很高的预后准确性，但在更早的时间点和院内心脏骤停（IHCA）后的表现研究较少。我们旨在评估 OHCA 和 IHCA 后 48 小时内的血浆 NfL，以预测长期预后。
这是一项在心脏骤停后入住重症监护病房的成年人中进行的观察性多中心队列研究。在入住重症监护病房时、心脏骤停后 12 小时和 48 小时，对收集的血浆进行 NfL 回顾性分析。使用神经功能预后量表（CPC）在 2 至 6 个月时评估结局，其中 CPC 1-2 为良好结局，CPC 3-5 为不良结局。通过接受者操作特征曲线下的面积（AUROC）来衡量预测性能。
428 例患者中，328 例（77%）发生 OHCA，100 例（23%）发生 IHCA。OHCA 患者中有 68%和 IHCA 患者中有 55%的预后不良。OHCA 后 12 小时和 48 小时，NfL 的总体预后性能均非常出色，AUROC 分别为 0.93 和 0.97。与 OHCA 相比，IHCA 后 12 小时和 48 小时的预测能力较低，AUROC 分别为 0.81 和 0.86（p≤0.03）。OHCA 和 IHCA 后入院时的 AUROC 分别为 0.77 和 0.67。OHCA 后 12 小时和 48 小时，高 NfL 水平可预测 95%特异性的不良预后，敏感性为 70%和 89%，而低 NfL 水平可预测 95%敏感性的良好预后，特异性为 71%和 74%，阴性预测值分别为 86%和 88%。
NfL 在预测 OHCA 后 12 小时内的良好和不良结局的准确性非常高。NfL 对 IHCA 后结局的预测可靠性较低。
