Bisulli Francesca, Muccioli Lorenzo, Taruffi Lisa, Bedin Roberta, Felici Silvia, Zenesini Corrado, Baccari Flavia, Gentile Mauro, Orlandi Niccolò, Rossi Simone, Nicodemo Marianna, d'Achille Fabio, Viale Pierluigi, Zaccaroni Stefania, Lodi Raffaele, Liguori Rocco, Zini Andrea, Guarino Maria, Cortelli Pietro, Lazzarotto Tiziana, Janigro Damir, Meletti Stefano
IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Ospedale Bellaria, Via Altura 3, 40139, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Neurol Sci. 2025 Feb;46(2):527-538. doi: 10.1007/s10072-024-07964-0. Epub 2025 Jan 8.
COVID-19 is associated with neurological complications, termed neuro-COVID, affecting patient outcomes. We aimed to evaluate the association between serum neurofilament light chain (NfL) and S100B biomarkers with the presence of neurological manifestations and functional prognosis in COVID-19 patients.
A multicenter prospective cohort study was conducted in three hospitals in the Emilia-Romagna region, Italy, from March 2020 to April 2022. Hospitalized patients with PCR-confirmed COVID-19 were enrolled. Serum S100B and NfL levels were measured in the acute or subacute phase after admission. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analyses. Statistical analyses were performed to evaluate the association between biomarkers, clinical/laboratory variables, and prognosis, specifically focusing on worsening of the modified Rankin Scale (mRS) from admission to discharge.
A total of 279 patients (153 males, median age 76.7 years) were included. Among them, 69 (24.7%) developed neuro-COVID. Serum NfL levels were significantly higher in the neuro-COVID group (median 110 vs 68.3; p = 0.035) and correlated with severe encephalopathy and extracranial neurologic manifestations. The ROC analysis showed low accuracy in the discrimination between the two groups for both NfL and S100B. Key predictors of worsening mRS included mechanical ventilation (OR = 9.56, 95% CI = 1.67-54.75; p = 0.011), severe encephalopathy (OR = 5.10, 95% CI = 1.58-16.19; p = 0.006), and elevated S100B levels (OR = 2.62, 95% CI = 1.10-6.46; p = 0.037).
Serum NfL and S100B biomarkers were not accurate in discriminating neuro-COVID patients, however NfL levels were associated with severe and extracranial neuro-COVID, while S100B with functional outcomes, potentially informing clinical management.
新型冠状病毒肺炎（COVID-19）与神经并发症相关，称为神经型COVID-19，会影响患者预后。我们旨在评估血清神经丝轻链（NfL）和S100B生物标志物与COVID-19患者神经表现的存在及功能预后之间的关联。
2020年3月至2022年4月，在意大利艾米利亚 - 罗马涅地区的三家医院进行了一项多中心前瞻性队列研究。纳入经PCR确诊的COVID-19住院患者。入院后急性期或亚急性期测量血清S100B和NfL水平。使用受试者操作特征（ROC）分析评估诊断准确性。进行统计分析以评估生物标志物、临床/实验室变量与预后之间的关联，特别关注从入院到出院改良Rankin量表（mRS）的恶化情况。
共纳入279例患者（153例男性，中位年龄76.7岁）。其中，69例（24.7%）发生神经型COVID-19。神经型COVID-19组血清NfL水平显著更高（中位值110对68.3；p = 0.035），且与严重脑病和颅外神经表现相关。ROC分析显示，NfL和S100B在两组鉴别中准确性较低。mRS恶化的关键预测因素包括机械通气（OR = 9.56，95%CI = 1.67 - 54.75；p = 0.011）、严重脑病（OR = 5.10，95%CI = 1.58 - 16.19；p = 0.006）和S100B水平升高（OR = 2.62，95%CI = 1.10 - 6.46；p = 0.037）。
血清NfL和S100B生物标志物在鉴别神经型COVID-19患者方面不准确，然而NfL水平与严重和颅外神经型COVID-19相关，而S100B与功能预后相关，可能为临床管理提供参考。
