All-Cause Mortality Differentials by Diabetes Status and Serum Neurofilament Light Chain Levels in U.S. General Adults.

Abstract

Neurofilament light chain (sNFL) increases in patients with diabetes and is associated with death. To examine whether sNFL mediates associations of diabetes with all-cause mortality and the extent of interaction or joint relations of sNFL and diabetes with mortality. Population based cohort study. 2013-2014 cycle of National Health and Nutrition Examination Survey. 2071 adults aged 20 to 75 years with measurements of sNFL. sNFL was lg transformed (LgNfl). Participants were featured whether LgNfl was higher than 1.48pg/ml or diagnosed with diabetes. All-cause mortality was the primary outcome obtained through linkage to registries. During a median follow-up of 6.1years, 85 participants died. Incidence rates [per 1000 person-years (95% CI)] of all-cause mortality were 27.78 (19.98∼35.58) in adults with LgNfl>1.48pg/ml and diabetes, 9.01 (1.99∼16.03) in adults with LgNfl>1.48pg/ml but no diabetes, 3.07 (1.01∼5.13) in adults with diabetes and LgNfl≤1.48pg/ml, and 2.21 (1.15∼3.27) in adults without diabetes and LgNfl≤1.48pg/ml. Significant interaction but not mediation was observed between LgNfl and diabetes. Compared with adults of no diabetes and LgNfl≤1.48pg/ml, those with diabetes and LgNfl > 1.48pg/ml had higher risks of all-cause mortality (Hazard ratio, 95%CI; 7.06, 3.52∼14.16). In general US adults with diabetes, elevated sNFL associated with higher all-cause mortality specifically, supporting an important role of sNFL in predicting health outcome in those with diabetes.