Cardiac arrest: serum NFL predicts long-term neurologic outcome

  • JAMA Neurol

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Among unconscious patients with out-of-hospital cardiac arrest, the serum neurofilament light chain (NFL) level at 24 hours predicted poor 6-month neurologic outcome.

Why this matters

  • Predicting neurologic outcome in this population remains challenging.

Key results

  • 50.2% of patients had poor neurologic outcome at 6 months.
  • Median serum NFL level higher in patients with poor vs good outcome:
    • 24 hours (1426 vs 37 pg/mL; P<.001>
    • 48 hours (3240 vs 46 pg/mL; P<.001>
    • 72 hours (3344 vs 54 pg/mL; P<.001>
  • Serum NFL level had high:
    • Overall performance (area under curve, 0.94-0.95);
    • Sensitivity and specificity (e.g., 69% and 98% at 24 hours).
  • It also outperformed serum tau, neuron-specific enolase, and S100.
  • Sensitivity for poor outcome was 29.2%-49.0% greater than that of routine electroencephalogram, somatosensory-evoked potentials, head CT, pupillary and corneal reflexes.
  • Adding serum NFL to clinical information improved discrimination (P<.001>

Study design

  • International prospective cohort study using data from randomized trial among 717 unconscious patients with out-of-hospital cardiac arrest, presumed cardiac origin.
  • Serum NFL levels measured with ultrasensitive immunoassay.
  • Main outcome: 6-month poor neurologic outcome (Cerebral Performance Category Scale category 3, 4, or 5).
  • Funding: Swedish Research Council; others.

Limitations

  • Assay not widely available.
  • External validation, establishment of reference ranges needed.

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