Department of Clinical Science, Neurosciences, Umeå University, SE-901 87, Umea, Sweden.
UmanDiagnostics®, Umea, Sweden.
Acta Neurochir (Wien). 2023 Oct;165(10):2793-2800. doi: 10.1007/s00701-023-05673-9. Epub 2023 Jun 23.
Prognostication of clinical outcome in patients suffering from aneurysmal subarachnoid haemorrhage (SAH) is a challenge. There are no biochemical markers in routine use that can aid in prognostication. Neurofilament light (NFL) measured in cerebrospinal fluid (CSF) has been associated with clinical outcome in previous studies.
To investigate if serum levels of NFL correlate with CSF levels and long-term clinical outcome in patients suffering from SAH.
We conducted an observational cohort study of 88 patients treated for SAH at Umeå University Hospital in 2014-2018. Serum and CSF samples were analysed using an enzyme-linked immunosorbent assay to quantify NFL levels. Outcome was assessed using Glasgow Outcome Scale Extended and dichotomised as favourable or unfavourable. Differences in NFL levels between outcome groups were analysed using repeated measurements ANOVA. Relationship between CSF and serum NFL levels was analysed using Pearson's correlation. A multivariate binary logistic regression model and a receiver operation characteristic curve were used to assess the predictive value of serum NFL.
A significant correlation between serum and CSF-NFL levels could be seen (Pearson's correlation coefficient = 0.7, p < .0001). Mean level of serum NFL was higher in the unfavourable outcome group than the favourable outcome group (p < .0001), in all epochs of SAH, and correlated with initial disease severity on the World Federation of Neurosurgical Societies scale. Serum NFL in the late phase displayed the best predictive potential in a receiver operation characteristic curve analysis (AUC=0.845, p < .0001).
Levels of NFL in serum and CSF are correlated. Early serum NFL levels seem to reflect initial tissue damage and serum NFL levels in the late phase may reflect secondary events such as vasospasm or delayed cerebral ischemia. Serum NFL may be used as a prognostic marker of clinical outcome in SAH.
预测蛛网膜下腔出血（SAH）患者的临床预后是一项挑战。目前尚无可用于预后评估的常规生化标志物。神经丝轻链（NFL）在脑脊液（CSF）中的水平与既往研究中的临床预后相关。
探讨 SAH 患者血清 NFL 水平与 CSF 水平及长期临床预后的相关性。
我们进行了一项观察性队列研究，纳入了 2014 年至 2018 年在于默奥大学医院接受治疗的 88 例 SAH 患者。使用酶联免疫吸附试验分析血清和 CSF 样本，以定量 NFL 水平。采用格拉斯哥预后量表扩展版（GOS-E）评估预后，并将其分为有利或不利。采用重复测量方差分析比较不同预后组之间的 NFL 水平差异。采用 Pearson 相关分析评估 CSF 和血清 NFL 水平之间的关系。采用多元二项逻辑回归模型和受试者工作特征曲线评估血清 NFL 的预测价值。
血清和 CSF-NFL 水平之间存在显著相关性（Pearson 相关系数=0.7，p<0.0001）。在所有 SAH 时期，不利结局组的血清 NFL 水平均高于有利结局组（p<0.0001），且与 WFNS 分级初始疾病严重程度相关。在受试者工作特征曲线分析中，晚期血清 NFL 具有最佳的预测潜力（AUC=0.845，p<0.0001）。
血清和 CSF 中的 NFL 水平相关。早期血清 NFL 水平似乎反映了初始组织损伤，晚期血清 NFL 水平可能反映了血管痉挛或迟发性脑缺血等继发性事件。血清 NFL 可能可作为 SAH 临床预后的预测标志物。
