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Meta-Analysis
. 2023 Sep 15;18(9):e0290619.
doi: 10.1371/journal.pone.0290619. eCollection 2023.

Neuroprognostication value of serum neurofilament light chain for out-of-hospital cardiac arrest: A systematic review and meta-analysis

Yu Fu  1   2 , Xiao-Tian Fan  1   2 , Hui Li  1   3 , Ran Zhang  3 , Ding-Ding Zhang  4 , Hao Jiang  5 , Zhi-Guo Chen  2 , Jiang-Tao Zhang  3
Affiliations
Meta-Analysis

Neuroprognostication value of serum neurofilament light chain for out-of-hospital cardiac arrest: A systematic review and meta-analysis

Yu Fu et al. PLoS One. .

Abstract

Background: Neurofilament light chain (NfL) is a novel biomarker for the assessment of neurological function after cardiac arrest (CA). Although meta-analysis has confirmed its predictive value, it has not conducted a more detailed analysis of its research. We conducted a meta-analysis to evaluate the relationship between serum NfL level and neurological prognosis in patients with spontaneous circulation recovery after CA, and subgroup analysis was conducted according to sample collection time, time to assess neurological function, study design, whether TTM was received, the method of specimen determination, and the presence of neurological disease in patients. To analyze the influence of these factors on the predictive value of serum NfL.

Methods: Published Cochrane reviews and an updated, extended search of MEDLINE, Cochrane Library, Embase, Scopus, ClinicalKey, CINAHL, and Web of Science for relevant studies until March 2022 were assessed through inclusion and exclusion criteria. The standard mean difference and 95% confidence interval were calculated using the random-effects model or fixed-effects model to assess the association between one variable factor NfL level and the outcome of CA patients. Subgroup analysis according to sample collection time was performed. The prognosis analysis and publication bias were also assessed using Egger's and Begg's tests.

Results: Among 1209 related articles for screening, 6 studies (1360 patients) met the inclusion criteria and were selected for meta-analysis. The level of serum NfL in the good prognosis group (CPC1-2, CPC: cerebral performance category score) was significantly lower than that in the poor prognosis group (CPC3-5)SMD(standardized mean difference) = 0.553, 95%CI(confidence interval) = 0.418-0.687, I2 = 65.5% P<0.05). And this relationship also exists at each sampling time point (NfL specimens were collected on admission: SMD:0.48,95%CI:0.24-0.73; Samples were collected 24 hours after CA: SMD:0.60,95%CI:0.32-0.88;Specimens were obtained 48 hours after CA: SMD:0.51, 95%CI:0.18-0.85;Specimens were obtained 72 hours after CA: SMD:0.59, 95%CI:0.38-0.81).

Conclusion: NfL may play a potential neuroprognostication role in postcardiac arrest patients with spontaneous circulation, regardless of when the sample was collected after CA.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart showing selection of the meta-analysis studies.
Fig 2
Fig 2. Data analysis: Statistical analysis of the prognosis of each study at different sampling times.
Fig 3
Fig 3. ROC: Receiver operating characteristic curve.
Fig 4
Fig 4. Subgroup analysis was performed at different sampling times.
0: NfL specimens were collected on admission; 1: Samples were collected 24 hours after CA; 2: Specimens were obtained 48 hours after CA; 3: Specimens were obtained 72 hours after CA.
Fig 5
Fig 5. NfL influence of time to assess neurological function on NfL prediction of neurological function.
See this image and copyright information in PMC

References

    1. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 2010;81:1479–87. doi: 10.1016/j.resuscitation.2010.08.006 - DOI - PubMed
    1. Neumar RW, Nolan JP, Adrie C, et al.. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation 2008;118:2452–83. doi: 10.1161/CIRCULATIONAHA.108.190652 - DOI - PubMed
    1. Tsuchida T, Ono K, Maekawa K, Hayamizu M, Hayakawa M. Effect of annual hospital admissions of out-of-hospital cardiac arrest patients on prognosis following cardiac arrest. BMC emergency medicine 2022;22:121. doi: 10.1186/s12873-022-00685-7 - DOI - PMC - PubMed
    1. Yuan A, Rao MV, Veeranna, Nixon RA. Neurofilaments and Neurofilament Proteins in Health and Disease. Cold Spring Harbor perspectives in biology 2017;9. doi: 10.1101/cshperspect.a018309 - DOI - PMC - PubMed
    1. Sandroni C, D’Arrigo S, Cacciola S, et al.. Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive care medicine 2020;46:1803–51. doi: 10.1007/s00134-020-06198-w - DOI - PMC - PubMed

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