Neurofilament light chain for prognostication after cardiac arrest-first steps towards validation

Area of Science:

• Neurology
• Biomarkers
• Critical Care Medicine

Background:

• Cardiac arrest survivors often remain comatose, necessitating accurate neuroprognostication.
• Neurofilament light chain (NfL) is a promising blood biomarker for neuronal injury, offering earlier assessment than current standards.
• Establishing reliable NfL cut-off levels is crucial for clinical application.

Purpose of the Study:

• To validate previously identified NfL thresholds for predicting poor neurological outcome in out-of-hospital cardiac arrest (OHCA) patients.
• To assess the diagnostic precision of NfL at 24-48 hours post-cardiac arrest.

Main Methods:

• Analysis of plasma samples from 638 comatose OHCA patients from the BOX trial.
• Quantification of NfL levels using ELISA.
• Evaluation of diagnostic performance using Area Under the Receiver Operator Curve (AUROC) and previously determined cut-offs.

Main Results:

• High diagnostic accuracy for predicting poor neurologic outcome (CPC > 2) with AUROC of 0.95 at both 24 and 48 hours.
• At 24 hours, a cut-off of 1232 pg/mL showed 98% specificity.
• At 48 hours, a cut-off of 1539 pg/mL also demonstrated 98% specificity.

Conclusions:

• The study confirms the prognostic value of NfL in identifying patients at risk of poor neurologic outcome post-cardiac arrest.
• Previously established NfL cut-offs (1232 pg/mL at 24h, 1539 pg/mL at 48h) demonstrated excellent specificity.
• NfL enables reliable neuroprognostication as early as 24 hours after cardiac arrest.