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Observational Study
. 2023 Oct;165(10):2793-2800.
doi: 10.1007/s00701-023-05673-9. Epub 2023 Jun 23.

Serum neurofilament light as a predictor of outcome in subarachnoid haemorrhage

Conny Johansson  1 , Helena Aineskog  2 , Lars-Owe D Koskinen  2 , Andreas Gunnarsson  3 , Peter Lindvall  2
Affiliations
Observational Study

Serum neurofilament light as a predictor of outcome in subarachnoid haemorrhage

Conny Johansson et al. Acta Neurochir (Wien). 2023 Oct.

Abstract

Background: Prognostication of clinical outcome in patients suffering from aneurysmal subarachnoid haemorrhage (SAH) is a challenge. There are no biochemical markers in routine use that can aid in prognostication. Neurofilament light (NFL) measured in cerebrospinal fluid (CSF) has been associated with clinical outcome in previous studies.

Objective: To investigate if serum levels of NFL correlate with CSF levels and long-term clinical outcome in patients suffering from SAH.

Methods: We conducted an observational cohort study of 88 patients treated for SAH at Umeå University Hospital in 2014-2018. Serum and CSF samples were analysed using an enzyme-linked immunosorbent assay to quantify NFL levels. Outcome was assessed using Glasgow Outcome Scale Extended and dichotomised as favourable or unfavourable. Differences in NFL levels between outcome groups were analysed using repeated measurements ANOVA. Relationship between CSF and serum NFL levels was analysed using Pearson's correlation. A multivariate binary logistic regression model and a receiver operation characteristic curve were used to assess the predictive value of serum NFL.

Results: A significant correlation between serum and CSF-NFL levels could be seen (Pearson's correlation coefficient = 0.7, p < .0001). Mean level of serum NFL was higher in the unfavourable outcome group than the favourable outcome group (p < .0001), in all epochs of SAH, and correlated with initial disease severity on the World Federation of Neurosurgical Societies scale. Serum NFL in the late phase displayed the best predictive potential in a receiver operation characteristic curve analysis (AUC=0.845, p < .0001).

Conclusion: Levels of NFL in serum and CSF are correlated. Early serum NFL levels seem to reflect initial tissue damage and serum NFL levels in the late phase may reflect secondary events such as vasospasm or delayed cerebral ischemia. Serum NFL may be used as a prognostic marker of clinical outcome in SAH.

Keywords: Cerebral vasospasm; Glasgow Outcome Scale; Neurofilament protein l; Subarachnoid haemorrhage.

PubMed Disclaimer

Conflict of interest statement

A.G. is employed by UmanDiagnostics® which has UmanDiagnostics NF-Light™ as a market product.

Figures

Fig. 1
Fig. 1
Scatterplot describing the relationship between serum and cerebrospinal fluid (CSF) levels of neurofilament light (NFL) collected at the same time. The x and y axes have natural logarithmic scales because of non-parametric data distribution. Twenty patients were sampled at two occasions. Pearson’s correlation coefficient = 0.7, p<.0001
Fig. 2
Fig. 2
Boxplot presenting the median and interquartile range of serum neurofilament light (sNFL) levels during different days since hospitalisation
Fig. 3
Fig. 3
Difference in serum neurofilament light (sNFL) levels between unfavourable and favourable outcome groups at different time epochs, analysed using a repeated measurements mixed ANOVA. Bonferroni-adjusted post hoc tests revealed significant difference (p<.0001) between outcome groups in all time epochs. GOSE, Glasgow outcome scale extended. ANOVA, analysis of variance
Fig. 4
Fig. 4
Receiver operating characteristic curve using levels of serum neurofilament light (NFL) for predicting an unfavourable outcome in the late phase (days 7–18 after arrival at hospital). AUC, area under the curve. CI, 95% confidence interval
See this image and copyright information in PMC

References

    1. Gafson AR, Barthélemy NR, Bomont P, Carare RO, Durham HD, Julien JP, Kuhle J, Leppert D, Nixon RA, Weller RO, Zetterberg H, Matthews PM. Neurofilaments: neurobiological foundations for biomarker applications. Brain. 2020;143:1975–1998. doi: 10.1093/brain/awaa098. - DOI - PMC - PubMed
    1. Galea JP, Dulhanty L, Patel HC. Predictors of outcome in aneurysmal subarachnoid hemorrhage patients: observations from a multicenter data set. Stroke. 2017;48:2958–2963. doi: 10.1161/strokeaha.117.017777. - DOI - PubMed
    1. Garland P, Morton M, Zolnourian A, Durnford A, Gaastra B, Toombs J, Heslegrave AJ, More J, Zetterberg H, Bulters DO, Galea I. Neurofilament light predicts neurological outcome after subarachnoid haemorrhage. Brain. 2021;144(3):761–768. doi: 10.1093/brain/awaa451. - DOI - PMC - PubMed
    1. Gendron TF, Badi MK, Heckman MG, Jansen-West KR, Vilanilam GK, Johnson PW, Burch AR, Walton RL, Ross OA, Brott TG, Miller TM, Berry JD, Nicholson KA, Wszolek ZK, Oskarsson BE, Sheth KN, Sansing LH, Falcone GJ, Cucchiara BL, Meschia JF, Petrucelli L. Plasma neurofilament light predicts mortality in patients with stroke. Sci Transl Med. 2020;12(569):eaay1913. doi: 10.1126/scitranslmed.aay1913. - DOI - PMC - PubMed
    1. Hviid CVB, Knudsen CS, Parkner T. Reference interval and preanalytical properties of serum neurofilament light chain in Scandinavian adults. Scand J Clin Lab Invest. 2020;80:291–295. doi: 10.1080/00365513.2020.1730434. - DOI - PubMed

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