Serum neurofilament light chain as outcome marker for intensive care unit patients

Anna Lena Fisse,Min-Suk Yoon,Ludwig Kappos,David Leppert,Xiomara Pedreiturria,Ralf Gold,Jens Kuhle,Kalliopi Pitarokoili,Jeremias Motte

doi:10.1007/s00415-020-10277-9

Abstract

ObjectiveNeurofilament light chain (NfL) in serum indicates neuro-axonal damage in diseases of the central and peripheral nervous system. Reliable markers to enable early estimation of clinical outcome of intensive care unit (ICU) patients are lacking. The aim of this study was to investigate, whether serum NfL levels are a possible biomarker for prediction of outcome of ICU patients.MethodsThirty five patients were prospectively examined from admission to ICU until discharge from the hospital or death. NfL levels were measured longitudinally by a Simoa assay.ResultsNfL was elevated in all ICU patients and reached its maximum at day 35 of ICU treatment. Outcome determined by modified Rankin Scale at the end of the follow-up period correlated with NfL level at admission, especially in the group of patients with impairment of the central nervous system (n = 25, r = 0.56, p = 0.02).ConclusionNfL could be used as a prognostic marker for outcome of ICU patients, especially in patients with impairment of the central nervous system.

Highlights

Neurofilaments (NfL) are structural scaffolding proteins in neurons and are known as a biomarker reflecting neuroaxonal damage in various neurological disorders [1]
Patients received nerve conduction studies and electromyography to detect a possible influence of critical illness polyneuromyopathy (CIPNM) on NfL levels
The correlation of NfL at baseline with the outcome modified Rankin Scale (mRS) in intensive care unit (ICU) patients with central nervous system (CNS) disease suggest that NfL could serve as a possible prognostic marker for these ICU patients

Summary

Introduction

Neurofilaments (NfL) are structural scaffolding proteins in neurons and are known as a biomarker reflecting neuroaxonal damage in various neurological disorders [1]. NfL is composed of subunits from Nf-L [neurofilament light], Nf-M [neurofilament middle], Nf-H [neurofilament heavy], a-internexin and peripherin [2]. Elevated levels of NfL are detectable in cerebrospinal fluid and serum and were described in diseases of the central nervous system like multiple sclerosis, dementia, stroke, traumatic brain injury etc.[1, 3, 4], and in disorders of the peripheral nervous system like Guillain–Barré syndrome and chronic inflammatory demyelination neuropathy [5,6,7]. Blood levels of neurofilaments were shown to monitor and predict progression in these diseases. NfL levels are general indicators of neuro-axonal damage irrespective of its cause

Methods

Results

Discussion

Conclusion