Neurofilament light as an outcome predictor after cardiac arrest : a post hoc analysis of the COMACARE trial

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COMACARE Study Grp , Wihersaari , L , Ashton , N J , Reinikainen , M , Jakkula , P , Pettilä , V , Hastbacka , J , Tiainen , M , Loisa , P , Friberg , H , Cronberg , T , Blennow , K , Zetterberg , H & Skrifvars , M B 2021 , ' Neurofilament light as an outcome predictor after cardiac arrest : a post hoc analysis of the COMACARE trial ' , Intensive Care Medicine , vol. 47 , no. 1 , pp. 39-48 . https://doi.org/10.1007/s00134-020-06218-9

Title: Neurofilament light as an outcome predictor after cardiac arrest : a post hoc analysis of the COMACARE trial
Author: COMACARE Study Grp; Wihersaari, Lauri; Ashton, Nicholas J.; Reinikainen, Matti; Jakkula, Pekka; Pettilä, Ville; Hastbacka, Johanna; Tiainen, Marjaana; Loisa, Pekka; Friberg, Hans; Cronberg, Tobias; Blennow, Kaj; Zetterberg, Henrik; Skrifvars, Markus B.
Contributor: University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, Clinicum
University of Helsinki, HUS Neurocenter
University of Helsinki, HYKS erva
University of Helsinki, HUS Emergency Medicine and Services
Date: 2021-01
Language: eng
Number of pages: 10
Belongs to series: Intensive Care Medicine
ISSN: 0342-4642
URI: http://hdl.handle.net/10138/325635
Abstract: Purpose Neurofilament light (NfL) is a biomarker reflecting neurodegeneration and acute neuronal injury, and an increase is found following hypoxic brain damage. We assessed the ability of plasma NfL to predict outcome in comatose patients after out-of-hospital cardiac arrest (OHCA). We also compared plasma NfL concentrations between patients treated with two different targets of arterial carbon dioxide tension (PaCO2), arterial oxygen tension (PaO2), and mean arterial pressure (MAP). Methods We measured NfL concentrations in plasma obtained at intensive care unit admission and at 24, 48, and 72 h after OHCA. We assessed neurological outcome at 6 months and defined a good outcome as Cerebral Performance Category (CPC) 1-2 and poor outcome as CPC 3-5. Results Six-month outcome was good in 73/112 (65%) patients. Forty-eight hours after OHCA, the median NfL concentration was 19 (interquartile range [IQR] 11-31) pg/ml in patients with good outcome and 2343 (587-5829) pg/ml in those with poor outcome,p <0.001. NfL predicted poor outcome with an area under the receiver operating characteristic curve (AUROC) of 0.98 (95% confidence interval [CI] 0.97-1.00) at 24 h, 0.98 (0.97-1.00) at 48 h, and 0.98 (0.95-1.00) at 72 h. NfL concentrations were lower in the higher MAP (80-100 mmHg) group than in the lower MAP (65-75 mmHg) group at 48 h (median, 23 vs. 43 pg/ml,p = 0.04). PaCO(2)and PaO(2)targets did not associate with NfL levels. Conclusions NfL demonstrated excellent prognostic accuracy after OHCA. Higher MAP was associated with lower NfL concentrations.
Subject: Cardiac arrest
Prognostication
Biomarkers
Neurofilament light (NfL)
NEURON-SPECIFIC ENOLASE
TARGETED TEMPERATURE MANAGEMENT
EUROPEAN RESUSCITATION COUNCIL
PROGNOSTICATION
SOCIETY
3126 Surgery, anesthesiology, intensive care, radiology
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