心脏骤停后血清神经丝轻链与多模态神经预后评估——一项回顾性队列研究

Serum neurofilament light chain and multimodal neuroprognostication after cardiac arrest - A retrospective cohort study.

作者信息

Czimmeck Constanze, Nee Jens, Hinrichs Carl, Endisch Christian, Körtvélyessy Péter, Ploner Christoph J, Leithner Christoph, Kenda Martin

机构信息

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, 13353 Berlin, Germany.

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Nephrology and Intensive Care Medicine, Circulatory Arrest Center Berlin, Berlin, Germany.

出版信息

Resuscitation. 2025 Aug;213:110650. doi: 10.1016/j.resuscitation.2025.110650. Epub 2025 May 21.

DOI:10.1016/j.resuscitation.2025.110650

PMID:40409670

Abstract

BACKGROUND AND PURPOSE

Most patients remain comatose within the first days after cardiac arrest (CA) and resuscitation. Guidelines recommend multimodal neuroprognostication including neuron specific enolase (NSE) as serum biomarker. Neurofilament light-chain (NFL) may have higher prognostic accuracy earlier after cardiac arrest and a lower risk of confounders. This study investigates the prognostic value of serum NFL in clinical routine compared to established prognostic tests.

METHODS

Monocentric retrospective observational study of patients with serum NFL between 24-96 h after CA. Neurological outcome was evaluated at hospital discharge via the Cerebral Performance Category score (CPC), dichotomized as good (CPC 1-3) and poor (CPC 4-5). Prognostic performance for good and poor neurological outcome prediction was analysed for NFL, NSE, electroencephalography (EEG), somatosensory evoked potentials (SSEP), and head computed tomography (CT). NFL was measured using the SIMOA Quanterix assay.

RESULTS

152 patients were included, median age was 61 years, 24% were female. 10 patients were discharged in vegetative state or comatose (7%), and 78 died before discharge (51%). NFL > 2000 pg/ml predicted poor outcome with 53% (43-63%) sensitivity and 100% (94-100%) specificity. Most patients (69%) with NFL < 55 pg/ml had a good outcome. Predictive accuracy was similar to other neuroprognostic tests (AUC 0.89, 0.84-0.94). In head-to-head comparisons with the other neuroprognostic tests, NFL identified 16-41% additional poor outcome patients.

CONCLUSION

NFL (SIMOA) > 2000 pg/ml predicts poor neurological outcome with high specificity, while low concentrations strongly argue against severe HIE. Adding NFL to established neuroprognostication tests increases sensitivity of poor outcome prediction.

摘要

背景与目的

大多数心脏骤停（CA）及复苏后的患者在最初几天内仍处于昏迷状态。指南推荐采用多模式神经预后评估，包括将神经元特异性烯醇化酶（NSE）作为血清生物标志物。神经丝轻链（NFL）在心脏骤停后早期可能具有更高的预后准确性，且混杂因素风险更低。本研究旨在探讨与既定预后检测方法相比，血清NFL在临床常规中的预后价值。

方法

对CA后24 - 96小时内检测血清NFL的患者进行单中心回顾性观察研究。在出院时通过脑功能分类评分（CPC）评估神经功能结局，分为良好（CPC 1 - 3）和不良（CPC 4 - 5）。分析NFL、NSE、脑电图（EEG）、体感诱发电位（SSEP）和头颅计算机断层扫描（CT）对良好和不良神经功能结局预测的预后性能。使用SIMOA Quanterix检测法测量NFL。

结果

纳入152例患者，中位年龄为61岁，24%为女性。10例患者出院时处于植物状态或昏迷（7%），78例在出院前死亡（51%）。NFL > 2000 pg/ml预测不良结局的敏感性为53%（43 - 63%），特异性为100%（94 - 100%）。大多数NFL < 55 pg/ml的患者结局良好（69%）。预测准确性与其他神经预后检测方法相似（AUC 0.89，0.84 - 0.94）。在与其他神经预后检测方法的直接比较中，NFL额外识别出16 - 41%结局不良的患者。