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. 2021 Jul 14;13(602):eabi7643.
doi: 10.1126/scitranslmed.abi7643. Epub 2021 Jun 15.

Serum neurofilament light protein correlates with unfavorable clinical outcomes in hospitalized patients with COVID-19

Mercedes Prudencio  1   2 , Young Erben  3 , Christopher P Marquez  4 , Karen R Jansen-West  1 , Camila Franco-Mesa  3 , Michael G Heckman  5 , Launia J White  5 , Judith A Dunmore  1 , Casey N Cook  1   2 , Meredith T Lilley  1 , Yuping Song  1 , Caroline F Harlow  4 , Björn Oskarsson  6 , Katharine A Nicholson  7 , Zbigniew K Wszolek  6 , LaTonya J Hickson  8 , John C O'Horo  9   10 , Jonathan B Hoyne  4 , Tania F Gendron  1   2 , James F Meschia  11 , Leonard Petrucelli  12   2
Affiliations

Serum neurofilament light protein correlates with unfavorable clinical outcomes in hospitalized patients with COVID-19

Mercedes Prudencio et al. Sci Transl Med. .

Abstract

Brain imaging studies of patients with COVID-19 show evidence of macro- and microhemorrhagic lesions, multifocal white matter hyperintensities, and lesions consistent with posterior reversible leukoencephalopathy. Imaging studies, however, are subject to selection bias, and prospective studies are challenging to scale. Here, we evaluated whether serum neurofilament light chain (NFL), a neuroaxonal injury marker, could predict the extent of neuronal damage in a cohort of 142 hospitalized patients with COVID-19. NFL was elevated in the serum of patients with COVID-19 compared to healthy controls, including those without overt neurological manifestations. Higher NFL serum concentrations were associated with worse clinical outcomes. In 100 hospitalized patients with COVID-19 treated with remdesivir, a trend toward lower NFL serum concentrations was observed. These data suggest that patients with COVID-19 may experience neuroaxonal injury and may be at risk for long-term neurological sequelae. Neuroaxonal injury should be considered as an outcome in acute pharmacotherapeutic trials for COVID-19.

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Figures

Fig. 1
Fig. 1. Serum NFL is elevated in hospitalized patients with COVID-19.
(A) Comparison of serum NFL between healthy controls (Controls, N = 55) and hospitalized patients with COVID-19 (mean NFL per patient, N = 142). Bars represent mean NFL concentrations with 95% CIs. Statistical differences were assessed using a stratified van Elteren Wilcoxon rank sum test, where the test was stratified by both age as a four-level categorical variable (based on sample quartiles) and sex. ****P < 0.001. (B) Serum NFL in 35 patients to highlight the range of NFL concentrations in longitudinally collected samples. The first and last NFL concentrations are indicated by a black and red dot, respectively, and mean concentrations for each patient are presented by the small black solid horizontal lines. (C) Serum NFL trends over time in the 35 patients with COVID-19 with longitudinal blood draws and for whom at least one NFL measurement is at least 3 SDs above the group mean of NFL in control individuals. NFL concentrations are shown on the base 10 logarithmic scale. The NFL concentration representing the mean control NFL + 3 SDs is indicated by a solid blue horizontal line.
See this image and copyright information in PMC

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