Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Neurovascular Disorders, Amsterdam Neurosciences, Amsterdam, the Netherlands.
Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Neurovascular Disorders, Amsterdam Neurosciences, Amsterdam, the Netherlands.
World Neurosurg. 2024 Sep;189:e238-e252. doi: 10.1016/j.wneu.2024.06.024. Epub 2024 Jun 10.
Neurofilament light chain (NfL), a biomarker reflecting neuro-axonal damage, may be useful in improving clinical outcome prediction after aneurysmal subarachnoid hemorrhage (aSAH). We explore the robust and additional value of NfL to neurologic and radiologic grading scales in predicting poor outcome after aSAH.
In this prospective cohort study conducted in a single tertiary center, blood samples were collected of aSAH patients within 24 hours after ictus and before endovascular/surgical intervention. The primary endpoint was poor outcome at 6 months' follow-up. Receiver operating curves (ROC), area under the curve (AUC, 95% CI) and model-fit (Nagelkerke R) were calculated for NfL, neurologic grading scale (WFNS), modified Fisher, age ,and sex. A combined ROC and AUC were calculated for variables with an AUC ≥ 0.70.
A total of 66 (42%) had poor outcome. The AUC of NfL for poor outcome was 0.70 (0.62-0.78). Combining NfL and WFNS resulted in a slightly higher model fit and not-significantly higher AUC for predicting poor outcome (R 0.51; AUC 0.86, 0.80-0.92) compared with WFNS alone. When patients were stratified according to hemorrhage severity, median NfL [IQR] levels were significantly higher in poor grade (14 [7-32] pg/mL) than good grade patients (7 [5-14] pg/mL). Within poor grade patients, median NfL [IQR] levels were significantly higher in non-survivors (19 [11-36] pg/mL) than survivors (7 [6-13] pg/mL).
In the entire aSAH cohort, plasma NfL has an acceptable predictive performance but does not improve clinical outcome prediction. However, NfL may have potential value in subgroups based on hemorrhage severity.
神经丝轻链（NfL）是一种反映神经轴突损伤的生物标志物，可能有助于提高蛛网膜下腔出血（aSAH）后临床预后的预测能力。我们探讨了 NfL 对神经学和影像学分级量表在预测 aSAH 后不良预后方面的稳健性和额外价值。
在这项单中心前瞻性队列研究中，在发病后 24 小时内且在血管内/手术干预前采集 aSAH 患者的血液样本。主要终点是 6 个月随访时的不良预后。计算 NfL、神经学分级量表（WFNS）、改良 Fisher 分级、年龄和性别预测不良预后的受试者工作特征曲线（ROC）、曲线下面积（AUC，95%CI）和模型拟合度（Nagelkerke R）。计算 AUC≥0.70 的变量的综合 ROC 和 AUC。
共有 66 例（42%）预后不良。NfL 预测不良预后的 AUC 为 0.70（0.62-0.78）。与 WFNS 单独相比，将 NfL 和 WFNS 结合起来预测不良预后时，模型拟合度略有提高，但 AUC 没有显著提高（R 0.51；AUC 0.86，0.80-0.92）。根据出血严重程度对患者进行分层后，不良分级患者的 NfL 中位数[四分位距]水平（14[7-32]pg/ml）明显高于良好分级患者（7[5-14]pg/ml）。在不良分级患者中，非幸存者的 NfL 中位数[四分位距]水平（19[11-36]pg/ml）明显高于幸存者（7[6-13]pg/ml）。
在整个 aSAH 队列中，血浆 NfL 具有可接受的预测性能，但不能提高临床预后预测能力。然而，NfL 可能在基于出血严重程度的亚组中具有潜在价值。
