Hyperphosphorylated neurofilament NF-H as a predictor of mortality after brain injury in children
Jiří Zurek1, Ludmila Bartlová, Michal Fedora
1Department of Anesthesia and Intensive Care, University Children's Hospital, Brno, Czech Republic. jzurek@fnbrno.cz
Insights
Serum levels of hyperphosphorylated neurofilament heavy chain (pNF-H) were significantly higher in children with severe traumatic brain injury (TBI). These findings suggest pNF-H may predict outcomes in pediatric TBI patients.
Area of Science:
- Neuroscience
- Biomarkers
- Pediatric Traumatology
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability in children.
- Accurate assessment of TBI severity and prediction of outcomes are crucial for effective management.
- Neurofilaments are structural proteins of neurons, and their release into circulation can indicate neuronal damage.
Purpose of the Study:
- To investigate the correlation between serum levels of hyperphosphorylated neurofilament heavy chain (pNF-H) and the severity of brain injury in children.
- To evaluate the potential of pNF-H as a prognostic biomarker for TBI outcomes in pediatric patients.
Main Methods:
- Prospective enrollment of 49 pediatric patients with TBI.
- Serial serum sampling for up to 6 days post-admission.
- Quantification of serum pNF-H concentrations using enzyme-linked immunosorbent assay (ELISA).
- Assessment of patient outcomes at 6 months post-TBI using the Glasgow Outcome Scale (GOS).
Main Results:
- Significantly elevated serum pNF-H levels were observed in patients with poor outcomes (GOS=1) on days 2-4 post-TBI.
- Higher pNF-H levels correlated with the presence of diffuse axonal injury on initial CT scans.
- Receiver Operating Characteristic (ROC) analysis was performed to identify optimal cut-off values for predicting poor GOS outcomes.
Conclusions:
- Serum pNF-H levels show a significant correlation with mortality and poor outcomes in pediatric TBI.
- pNF-H may serve as a valuable predictive biomarker for assessing TBI severity and prognosis in children.
- Further prospective studies are warranted to validate these findings and establish clinical utility.
Objective:
The aim of the study was to determine whether serum levels of hyperphosphorylated neurofilament NF-H correlate with severity of brain injury in children.
Methods:
Forty-nine patients with traumatic brain injury (TBI) were enrolled into the prospective study. Venous blood samples were taken after admission and every 24 h for a maximum of 6 consecutive days. Serum NF-H concentrations were quantified by enzyme-linked immunosorbent assay. The outcome was evaluated 6 months after TBI using Glasgow Outcome Scale (GOS) in all patients.
Results:
The quantitative level of pNF-H remained significantly higher in patients with poor outcome (GOS = 1) in comparison with the other patients for the 2nd-4th day (p = 0.027; p = 0.019; p = 0.01). Levels of pNF-H were significantly higher in patients with diffuse axonal injury on initial CT scan (p = 0.004). Normal levels pNF-H in the paediatric population are unknown. Objective ROC analysis was identification of optimal cut-offs of proteins for prediction of GOS = 1.
Conclusions:
Although further, prospective study is warranted, these findings suggest that levels of hyperphosphorylated neurofilament NF-H correlate with mortality and may be useful as predictors of outcome in children with TBI.
