Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial

• Published in: Intensive care medicine Vol. 47; no. 1; pp. 39 - 48
• Main Authors: Wihersaari, Lauri, Ashton, Nicholas J., Reinikainen, Matti, Jakkula, Pekka, Pettilä, Ville, Hästbacka, Johanna, Tiainen, Marjaana, Loisa, Pekka, Friberg, Hans, Cronberg, Tobias, Blennow, Kaj, Zetterberg, Henrik, Skrifvars, Markus B.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2021; Springer; Springer Nature B.V
• Subjects: Anestesi och intensivvård; Anesthesiology; Anesthesiology and Intensive Care; Biomarkers; Blood pressure; Brain damage; Brain injury; Carbon dioxide; Carbon dioxide tension; Cardiac and Cardiovascular Systems; Cardiac arrest; Care and treatment; Clinical Medicine; Clinical outcomes; Coma; Comparative analysis; Confidence intervals; Critical Care Medicine; Damage assessment; Emergency Medicine; european; General & Internal Medicine; Heart; Heart attacks; Hypoxia; Intensive; Intensive care; Kardiologi; Klinisk medicin; Medical and Health Sciences; Medical prognosis; Medical research; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Medicine, Experimental; Neurodegeneration; Neurofilament light (NfL); neuron-specific enolase; Neurons; Neurophysiology; Original; Oxygen tension; Pain Medicine; Patient outcomes; Pediatrics; Pneumology/Respiratory System; Prognostication; resuscitation council; society; targeted temperature management; Canada; Finland; Biomarkers; Neurofilament light (NfL); Prognostication; Cardiac arrest
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-020-06218-9

Purpose Neurofilament light (NfL) is a biomarker reflecting neurodegeneration and acute neuronal injury, and an increase is found following hypoxic brain damage. We assessed the ability of plasma NfL to predict outcome in comatose patients after out-of-hospital cardiac arrest (OHCA). We also compared plasma NfL concentrations between patients treated with two different targets of arterial carbon dioxide tension (PaCO 2 ), arterial oxygen tension (PaO 2 ), and mean arterial pressure (MAP). Methods We measured NfL concentrations in plasma obtained at intensive care unit admission and at 24, 48, and 72 h after OHCA. We assessed neurological outcome at 6 months and defined a good outcome as Cerebral Performance Category (CPC) 1–2 and poor outcome as CPC 3–5. Results Six-month outcome was good in 73/112 (65%) patients. Forty-eight hours after OHCA, the median NfL concentration was 19 (interquartile range [IQR] 11–31) pg/ml in patients with good outcome and 2343 (587–5829) pg/ml in those with poor outcome, p  < 0.001. NfL predicted poor outcome with an area under the receiver operating characteristic curve (AUROC) of 0.98 (95% confidence interval [CI] 0.97–1.00) at 24 h, 0.98 (0.97–1.00) at 48 h, and 0.98 (0.95–1.00) at 72 h. NfL concentrations were lower in the higher MAP (80–100 mmHg) group than in the lower MAP (65–75 mmHg) group at 48 h (median, 23 vs. 43 pg/ml, p  = 0.04). PaCO 2 and PaO 2 targets did not associate with NfL levels. Conclusions NfL demonstrated excellent prognostic accuracy after OHCA. Higher MAP was associated with lower NfL concentrations.