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Bayoumy S, Verberk IMW, Vermunt L, Willemse E, den Dulk B, van der Ploeg AT, Pajkrt D, Nitz E, van den Hout JMP, van der Post J, Wolf NI, Beerepoot S, Groen EJN, Tüngler V, Teunissen CE. Neurofilament light protein as a biomarker for spinal muscular atrophy: a review and reference ranges. Clin Chem Lab Med 2024; 62:1252-1265. [PMID: 38215341 DOI: 10.1515/cclm-2023-1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
Spinal muscular atrophy (SMA) is the leading genetic cause of infant mortality, characterized by progressive neuromuscular degeneration resulting from mutations in the survival motor neuron (SMN1) gene. The availability of disease-modifying therapies for SMA therapies highlights the pressing need for easily accessible and cost-effective blood biomarkers to monitor treatment response and for better disease management. Additionally, the wide implementation of newborn genetic screening programs in Western countries enables presymptomatic diagnosis of SMA and immediate treatment administration. However, the absence of monitoring and prognostic blood biomarkers for neurodegeneration in SMA hinders effective disease management. Neurofilament light protein (NfL) is a promising biomarker of neuroaxonal damage in SMA and reflects disease progression in children with SMA undergoing treatment. Recently, the European Medicines Agency issued a letter of support endorsing the potential utilization of NfL as a biomarker of pediatric neurological diseases, including SMA. Within this review, we comprehensively assess the potential applications of NfL as a monitoring biomarker for disease severity and treatment response in pediatric-onset SMA. We provide reference ranges for normal levels of serum based NfL in neurologically healthy children aged 0-18 years. These reference ranges enable accurate interpretation of NfL levels in children and can accelerate the implementation of NfL into clinical practice.
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Affiliation(s)
- Sherif Bayoumy
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inge M W Verberk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lisa Vermunt
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Eline Willemse
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ben den Dulk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dasja Pajkrt
- Organovir Labs, Department of Pediatric Infectious Diseases, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisa Nitz
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Johanna M P van den Hout
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Julie van der Post
- Organovir Labs, Department of Pediatric Infectious Diseases, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole I Wolf
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Center, VU University Amsterdam, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
| | - Shanice Beerepoot
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Center, VU University Amsterdam, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ewout J N Groen
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Victoria Tüngler
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
- University Center for Rare Diseases, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Eggertsen PP, Palmfeldt J, Pedersen AR, Frederiksen OV, Olsen RKJ, Nielsen JF. Serum neurofilament light chain, inflammatory markers, and kynurenine metabolites in patients with persistent post-concussion symptoms: A cohort study. J Neurol Sci 2024; 460:123016. [PMID: 38636323 DOI: 10.1016/j.jns.2024.123016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/29/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Concussion leads to persistent post-concussion symptoms (PPCS) in up to one-third of those affected. While previous research has linked the initial trauma to elevated serum levels of neurofilament light chain (NFL), inflammatory markers, and neurotoxic metabolites within the kynurenine pathway, few studies have explored their relevance in PPCS. This study aims to investigate these biomarkers in PPCS patients, elucidating their relevance in the prolonged phase of concussion. METHODS Serum samples from 86 PPCS individuals aged 18-30 years, 2-6 months post-trauma were analyzed, with 54 providing follow-up samples after seven months. NFL was measured using single-molecule array (Simoa) technology, 13 inflammatory markers via a Luminex immunoassay, and five kynurenine metabolites using liquid chromatography-mass spectrometry. A control group of 120 healthy anonymous blood donors was recruited for comparison. RESULTS No significant NFL differences were found in PPCS participants compared with healthy individuals (p = 0.22). Intriguingly, a subset (9.3%) of PPCS participants initially exhibited abnormally high NFL levels (>9.7 pg/mL), which normalized upon follow-up (p = 0.032). Additionally, serum levels of the inflammatory markers, monocyte chemoattractant protein-1 (MCP-1/CCL2), and eotaxin-1/CCL11 were 25-40% lower than in healthy individuals (p ≤ 0.001). As hypothesized, PPCS participants exhibited a 22% reduction in the ratio of kynurenic acid to quinolinic acid (neuroprotective index) (p < 0.0001), indicating a shift towards the formation of neurotoxic metabolites. CONCLUSION NFL may serve as a biomarker to monitor recovery, and future studies should investigate the potential therapeutic benefits of modulating the kynurenine pathway to improve PPCS.
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Affiliation(s)
- Peter Preben Eggertsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Voldbyvej 15A, Hammel 8450, Denmark; Research Unit for Molecular Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark.
| | - Johan Palmfeldt
- Research Unit for Molecular Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
| | - Asger Roer Pedersen
- University Research Clinic for Innovative Patient Pathways, Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1, Silkeborg 8600, Denmark
| | | | - Rikke Katrine Jentoft Olsen
- Research Unit for Molecular Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Voldbyvej 15A, Hammel 8450, Denmark
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Datta D, Gopinadhan A, Soto A, Bangirana P, Opoka RO, Conroy AL, Saykin AJ, Kawata K, John CC. Blood biomarkers of neuronal injury in paediatric cerebral malaria and severe malarial anaemia. Brain Commun 2023; 5:fcad323. [PMID: 38075948 PMCID: PMC10710298 DOI: 10.1093/braincomms/fcad323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/04/2023] [Accepted: 11/25/2023] [Indexed: 02/12/2024] Open
Abstract
Persistent neurodisability is a known complication in paediatric survivors of cerebral malaria and severe malarial anaemia. Tau, ubiquitin C-terminal hydrolase-L1, neurofilament-light chain, and glial fibrillary acidic protein have proven utility as biomarkers that predict adverse neurologic outcomes in adult and paediatric disorders. In paediatric severe malaria, elevated tau is associated with mortality and neurocognitive complications. We aimed to investigate whether a multi-analyte panel including ubiquitin C-terminal hydrolase-L1, neurofilament-light chain, and glial fibrillary acidic protein can serve as biomarkers of brain injury associated with mortality and neurodisability in cerebral malaria and severe malarial anaemia. In a prospective cohort study of Ugandan children, 18 months to 12 years of age with cerebral malaria (n = 182), severe malarial anaemia (n = 158), and asymptomatic community children (n = 118), we measured admission blood levels of ubiquitin C-terminal hydrolase-L1, neurofilament-light chain, and glial fibrillary acidic protein. We investigated differences in biomarker levels, associations with mortality, blood-brain barrier integrity, neurodeficits and cognitive Z-scores in survivors up to 24-month follow-up. Admission ubiquitin C-terminal hydrolase-L1 levels were elevated >95th percentile of community children in 71 and 51%, and neurofilament-light chain levels were elevated >95th percentile of community children in 40 and 37% of children with cerebral malaria and severe malarial anaemia, respectively. Glial fibrillary acidic protein was not elevated in disease groups compared with controls. In cerebral malaria, elevated neurofilament-light chain was observed in 16 children who died in hospital compared with 166 survivors (P = 0.01); elevations in ubiquitin C-terminal hydrolase-L1 levels were associated with degree of blood-brain barrier disruption (P = 0.01); and the % predictive value for neurodeficits over follow-up (discharge, 6-, 12-, and 24 months) increased for ubiquitin C-terminal hydrolase-L1 (60, 67, 72, and 83), but not neurofilament-light chain (65, 68, 60, and 67). In cerebral malaria, elevated ubiquitin C-terminal hydrolase-L1 was associated with worse memory scores in children <5 years at malaria episode who crossed to over 5 years old during follow-up cognitive testing [β -1.13 (95% confidence interval -2.05, -0.21), P = 0.02], and elevated neurofilament-light chain was associated with worse attention in children ≥5 years at malaria episode and cognitive testing [β -1.08 (95% confidence interval -2.05, -1.05), P = 0.03]. In severe malarial anaemia, elevated ubiquitin C-terminal hydrolase-L1 was associated with worse attention in children <5 years at malaria episode and cognitive testing [β -0.42 (95% confidence interval -0.76, -0.07), P = 0.02]. Ubiquitin C-terminal hydrolase-L1 and neurofilament-light chain levels are elevated in paediatric cerebral malaria and severe malarial anaemia. In cerebral malaria, elevated neurofilament-light chain is associated with mortality whereas elevated ubiquitin C-terminal hydrolase-L1 is associated with blood-brain barrier dysfunction and neurodeficits over follow-up. In cerebral malaria, both markers are associated with worse cognition, while in severe malarial anaemia, only ubiquitin C-terminal hydrolase-L1 is associated with worse cognition.
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Affiliation(s)
- Dibyadyuti Datta
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Adnan Gopinadhan
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Alejandro Soto
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Paul Bangirana
- Department of Psychiatry, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
- Global Health Uganda, P.O. Box 33842, Kampala, Uganda
| | - Robert O Opoka
- Global Health Uganda, P.O. Box 33842, Kampala, Uganda
- Aga Khan University Medical College, P.O. Box 30270, Nairobi, Kenya
| | - Andrea L Conroy
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Andrew J Saykin
- Indiana Alzheimer’s Disease Research Center and Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, USA
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Swaney EEK, Cai T, Seal ML, Ignjatovic V. Blood biomarkers of secondary outcomes following concussion: A systematic review. Front Neurol 2023; 14:989974. [PMID: 36925940 PMCID: PMC10011122 DOI: 10.3389/fneur.2023.989974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 01/31/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Blood biomarkers have been identified as an alternative tool for predicting secondary outcomes following concussion. This systematic review aimed to summarize the literature on blood biomarkers of secondary outcomes following concussion in both pediatric and adult cohorts. Methods A literature search of Embase, Medline and PubMed was conducted. Two reviewers independently assessed retrieved studies to determine inclusion in systematic review synthesis. Results A total of 1771 unique studies were retrieved, 58 of which were included in the final synthesis. S100B, GFAP and tau were identified as being associated with secondary outcomes following concussion. Seventeen percent of studies were performed in a solely pediatric setting. Conclusions Validation of biomarkers associated with secondary outcomes following concussion have been largely limited by heterogeneous study cohorts and definitions of concussion and mTBI, presenting a hurdle for translation of these markers into clinical practice. Additionally, there was an underrepresentation of studies which investigated pediatric cohorts. Adult markers are not appropriate for children, therefore pediatric specific markers of secondary outcomes following concussion present the biggest gap in this field.
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Affiliation(s)
- Ella E K Swaney
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Tengyi Cai
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Marc L Seal
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Vera Ignjatovic
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
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Verduyn C, Bjerke M, Duerinck J, Engelborghs S, Peers K, Versijpt J, D'haeseleer M. CSF and Blood Neurofilament Levels in Athletes Participating in Physical Contact Sports: A Systematic Review. Neurology 2021; 96:705-715. [PMID: 33637627 DOI: 10.1212/wnl.0000000000011750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate whether participating in physical contact sports is associated with a release of neurofilaments and whether such release is related to future clinical neurologic and/or psychiatric impairment. METHODS We performed a systematic review of the PubMed, MEDLINE, and Cochrane Library databases using a combination of the search terms neurofilament(s)/intermediate filament and sport(s)/athletes. Original studies, written in English, reporting on neurofilaments in CSF and/or serum/plasma of contact sport athletes were included. This review was conducted following the Preferred Reporting Items for Systematic Review and Analyses guidelines. RESULTS Eighteen studies in 8 different contact sports (i.e., boxing, American football, ice hockey, soccer, mixed martial arts, lacrosse, rugby, and wrestling) matched our criteria. Elevated light chain neurofilament (NfL) levels were described in 13/18 cohorts. Most compelling evidence was present in boxing and American football, where exposure-related increases were appreciable at the intraindividual level (up to 4.1- and 2.0-fold, respectively) in well-defined groups. Differences in exposure severity (including previous cumulative effects), sampling/measurement time points (with regard to expected peak values), and definitions of the baseline setting are considered as main contributors to the variability in findings. No studies were encountered that have investigated the relationship with the targeted clinical end points; therefore no NfL cutoffs exist that are associated with a poor outcome. CONCLUSION NfL release can be seen, as a potential marker of neuronal brain damage, in participants of physical contact sports, particularly boxing and American football. The exact significance regarding the risk for future clinical impairment remains to be elucidated.
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Affiliation(s)
- Carl Verduyn
- From the Department of Physical Medicine and Rehabilitation (C.V., K.P.), Universitair Ziekenhuis Leuven; Katholieke Universiteit Leuven; Center for Neurosciences (M.B., J.D., S.E., J.V., M.D.), Vrije Universiteit Brussel; Reference Center for Biological Markers of Dementia (M.B., S.E.), Institute Born-Bunge, Universiteit Antwerpen; Neurochemistry Laboratory (M.B.), Department of Clinical Biology, Universitair Ziekenhuis Brussel; Department of Neurosurgery (J.D.), Universitair Ziekenhuis Brussel; Department of Neurology (S.E., J.V., M.D.), Universitair Ziekenhuis Brussel; and Nationaal Multiple Sclerose Centrum (M.D.); Melsbroek, Belgium.
| | - Maria Bjerke
- From the Department of Physical Medicine and Rehabilitation (C.V., K.P.), Universitair Ziekenhuis Leuven; Katholieke Universiteit Leuven; Center for Neurosciences (M.B., J.D., S.E., J.V., M.D.), Vrije Universiteit Brussel; Reference Center for Biological Markers of Dementia (M.B., S.E.), Institute Born-Bunge, Universiteit Antwerpen; Neurochemistry Laboratory (M.B.), Department of Clinical Biology, Universitair Ziekenhuis Brussel; Department of Neurosurgery (J.D.), Universitair Ziekenhuis Brussel; Department of Neurology (S.E., J.V., M.D.), Universitair Ziekenhuis Brussel; and Nationaal Multiple Sclerose Centrum (M.D.); Melsbroek, Belgium
| | - Johnny Duerinck
- From the Department of Physical Medicine and Rehabilitation (C.V., K.P.), Universitair Ziekenhuis Leuven; Katholieke Universiteit Leuven; Center for Neurosciences (M.B., J.D., S.E., J.V., M.D.), Vrije Universiteit Brussel; Reference Center for Biological Markers of Dementia (M.B., S.E.), Institute Born-Bunge, Universiteit Antwerpen; Neurochemistry Laboratory (M.B.), Department of Clinical Biology, Universitair Ziekenhuis Brussel; Department of Neurosurgery (J.D.), Universitair Ziekenhuis Brussel; Department of Neurology (S.E., J.V., M.D.), Universitair Ziekenhuis Brussel; and Nationaal Multiple Sclerose Centrum (M.D.); Melsbroek, Belgium
| | - Sebastiaan Engelborghs
- From the Department of Physical Medicine and Rehabilitation (C.V., K.P.), Universitair Ziekenhuis Leuven; Katholieke Universiteit Leuven; Center for Neurosciences (M.B., J.D., S.E., J.V., M.D.), Vrije Universiteit Brussel; Reference Center for Biological Markers of Dementia (M.B., S.E.), Institute Born-Bunge, Universiteit Antwerpen; Neurochemistry Laboratory (M.B.), Department of Clinical Biology, Universitair Ziekenhuis Brussel; Department of Neurosurgery (J.D.), Universitair Ziekenhuis Brussel; Department of Neurology (S.E., J.V., M.D.), Universitair Ziekenhuis Brussel; and Nationaal Multiple Sclerose Centrum (M.D.); Melsbroek, Belgium
| | - Koenraad Peers
- From the Department of Physical Medicine and Rehabilitation (C.V., K.P.), Universitair Ziekenhuis Leuven; Katholieke Universiteit Leuven; Center for Neurosciences (M.B., J.D., S.E., J.V., M.D.), Vrije Universiteit Brussel; Reference Center for Biological Markers of Dementia (M.B., S.E.), Institute Born-Bunge, Universiteit Antwerpen; Neurochemistry Laboratory (M.B.), Department of Clinical Biology, Universitair Ziekenhuis Brussel; Department of Neurosurgery (J.D.), Universitair Ziekenhuis Brussel; Department of Neurology (S.E., J.V., M.D.), Universitair Ziekenhuis Brussel; and Nationaal Multiple Sclerose Centrum (M.D.); Melsbroek, Belgium
| | - Jan Versijpt
- From the Department of Physical Medicine and Rehabilitation (C.V., K.P.), Universitair Ziekenhuis Leuven; Katholieke Universiteit Leuven; Center for Neurosciences (M.B., J.D., S.E., J.V., M.D.), Vrije Universiteit Brussel; Reference Center for Biological Markers of Dementia (M.B., S.E.), Institute Born-Bunge, Universiteit Antwerpen; Neurochemistry Laboratory (M.B.), Department of Clinical Biology, Universitair Ziekenhuis Brussel; Department of Neurosurgery (J.D.), Universitair Ziekenhuis Brussel; Department of Neurology (S.E., J.V., M.D.), Universitair Ziekenhuis Brussel; and Nationaal Multiple Sclerose Centrum (M.D.); Melsbroek, Belgium
| | - Miguel D'haeseleer
- From the Department of Physical Medicine and Rehabilitation (C.V., K.P.), Universitair Ziekenhuis Leuven; Katholieke Universiteit Leuven; Center for Neurosciences (M.B., J.D., S.E., J.V., M.D.), Vrije Universiteit Brussel; Reference Center for Biological Markers of Dementia (M.B., S.E.), Institute Born-Bunge, Universiteit Antwerpen; Neurochemistry Laboratory (M.B.), Department of Clinical Biology, Universitair Ziekenhuis Brussel; Department of Neurosurgery (J.D.), Universitair Ziekenhuis Brussel; Department of Neurology (S.E., J.V., M.D.), Universitair Ziekenhuis Brussel; and Nationaal Multiple Sclerose Centrum (M.D.); Melsbroek, Belgium
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Abstract
OBJECTIVES To characterize neurofilament light levels in children who achieved return of spontaneous circulation following cardiac arrest compared with healthy controls and determine an association between neurofilament light levels and clinical outcomes. DESIGN Retrospective cohort study. SETTING Academic quaternary PICU. PATIENTS Children with banked plasma samples from an acute respiratory distress syndrome biomarker study who achieved return of spontaneous circulation after a cardiac arrest and healthy controls. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Neurofilament light levels were determined with a highly sensitive single molecule array digital immunoassay. Patients were categorized into survivors and nonsurvivors and into favorable (Pediatric Cerebral Performance Category score of 1-2 or unchanged from baseline) or unfavorable (Pediatric Cerebral Performance Category score of 3-6 or Pediatric Cerebral Performance Category score change ≥1 from baseline). Associations between neurofilament light level and outcomes were determined using Wilcoxon rank-sum test. We enrolled 32 patients with cardiac arrest and 18 healthy controls. Demographics, severity of illness, and baseline Pediatric Cerebral Performance Category scores were similar between survivors and nonsurvivors. Healthy controls had lower median neurofilament light levels than patients after cardiac arrest (5.5 [interquartile range 5.0-8.2] vs 31.0 [12.0-338.6]; p < 0.001). Neurofilament light levels were higher in nonsurvivors than survivors (78.5 [26.2-509.1] vs 12.4 [10.3-28.2]; p = 0.012) and higher in survivors than healthy controls (p = 0.009). The four patients who survived with a favorable outcome had neurofilament light levels that were not different from patients with unfavorable outcomes (21.9 [8.5--35.7] vs 37.2 [15.4-419.1]; p = 0.60) although two of the four patients who survived with favorable outcomes had progressive encephalopathies with both baseline and postcardiac arrest Pediatric Cerebral Performance Category scores of 4. CONCLUSIONS Neurofilament light is a blood biomarker of hypoxic-ischemic brain injury and may help predict survival and neurologic outcome after pediatric cardiac arrest. Further study in a larger, dedicated cardiac arrest cohort with serial longitudinal measurements is warranted.
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