Serum neurofilament light chain as a predictive marker of neurologic outcome after cardiac arrest: a meta-analysis

Abstract

Objective: Recently, an increasing number of studies have suggested using serum neurofilament light (NfL) chain to predict the neurologic outcome after cardiac arrest. However, the predictive ability of this approach remains inconclusive. Meta-analysis was performed on related studies to assess the ability of serum NfL to predict the neurologic outcome after cardiac arrest.

Materials and methods: PubMed, ScienceDirect and Embase were systematically searched from the date of their inception until June 2022. Data were extracted to calculate the area under the receiver operating characteristic curve (AUC), the sensitivity, the specificity and the publication bias to evaluate the predictive power of serum NfL using Stata 14.0.

Results: Nine studies were included in the present meta-analysis. Seven studies involving 1296 participants reported serum NfL 24 h post arrest for predicting the neurological outcome, and the AUC was 0.92 (77% sensitivity and 96% specificity). Seven studies involving 1020 participants reported serum NfL 48 h post arrest for predicting the neurological outcome, and the AUC was 0.94 (78% sensitivity and 98% specificity). Four studies involving 804 participants reported serum NfL 72 h post arrest for predicting the neurological outcome, and the AUC was 0.96 (90% sensitivity and 98% specificity). No significant publication bias was observed among the included studies.

Conclusion: The present meta-analysis results support the potential use of serum NfL as an early biomarker of neurologic outcome, especially 72 h post arrest.

Keywords: Brain injury; Cardiac arrest; Cardiopulmonary resuscitation; Neurofilament light.

Fig. 1

Flow chart for the selection of studies

Fig. 2

Comparison of serum NfL levels across groups and time points. NfL Neurofilament light

Fig. 3

Serum NfL levels 24 h post arrest for predicting poor neurological outcome. A Forest plot of the ORs for NfL and poor neurological outcome, B summary receiver operating characteristics curve of NfL for predicting poor neurological outcome and C funnel plot for detecting publication bias. NfL Neurofilament light

Fig. 4

Serum NfL levels 48 h post arrest for predicting poor neurological outcome. A Forest plot of ORs for NfL and poor neurological outcome, B summary receiver operating characteristics curve of NfL for predicting poor neurological outcome, and C funnel plot for detecting publication bias. NfL Neurofilament light

Fig. 5

Serum NfL levels 72 h post arrest for predicting poor neurological outcome. A Forest plot of the ORs for NfL and poor neurological outcome, B Summary receiver operating characteristics curve of NfL for predicting poor neurological outcome and C funnel plot for detecting publication bias. NfL Neurofilament light