Neurofilament light chain but not glial fibrillary acidic protein is a potential biomarker of overt hepatic encephalopathy in patients with cirrhosis

• Published in: Annals of hepatology Vol. 29; no. 3; p. 101496
• Main Authors: de Wit, Koos, van Doorn, Diederick J., Mol, Bregje, van Vught, Lonneke A., Nevens, Frederik, Beuers, Ulrich, Ponsioen, Cyriel Y., Teunissen, Charlotte E., Takkenberg, R. Bart
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier España, S.L.U 01.05.2024; Elsevier
• Subjects: Adult; Aged; Biomarkers - blood; Brain diseases; Case-Control Studies; Female; Glial Fibrillary Acidic Protein - blood; Hepatic Encephalopathy - blood; Hepatic Encephalopathy - diagnosis; Hepatic Encephalopathy - etiology; Humans; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver diseases; Male; Metabolism; Middle Aged; Neurofilament Proteins - blood; Neuroproteins; Predictive Value of Tests; Prospective Studies; Severity of Illness Index; PSC; Liver diseases; Neuroproteins; Simoa; mHE; Metabolism; oHE; GFAP; MELD; NfL; CSF; ICU; HE; Brain diseases; TIPS
• DOI: 10.1016/j.aohep.2024.101496
• ISSN: 1665-2681

Hepatic encephalopathy (HE) is a frequent complication of cirrhosis and may cause cerebral damage. Neurodegenerative diseases can induce the release of neuroproteins like neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in body fluids, including blood plasma. We investigated whether NfL and GFAP could serve as potential diagnostic plasma biomarkers for overt HE (oHE). We included 85 patients from three prospective cohorts with different stages of liver disease and HE severity. The following patients were included: 1) 34 patients with primary sclerosing cholangitis (PSC) with compensated disease; 2) 17 patients with advanced liver disease without oHE before elective transjugular intrahepatic portosystemic shunt (TIPS) placement; 3) 17 intensive care unit (ICU) patients with oHE and 17 ICU patients without cirrhosis or oHE. Plasma NfL and GFAP were measured using single molecule assays. ICU oHE patients had higher NfL concentrations compared to pre-TIPS patients or ICU controls (p < 0.05, each). Median GFAP concentrations were equal in the ICU oHE and pre-TIPS patients or ICU controls. Plasma NfL and GFAP concentrations correlated with Model for End-Stage Liver Disease (MELD) scores (R = 0.58 and R = 0.40, p < 0.001, each). Plasma NfL deserves further evaluation as potential diagnostic biomarker for oHE and correlates with the MELD score.