• Sabina Hunziker, Adrian Quinto, Maja Ramin-Wright, Christoph Becker, Katharina Beck, Alessia Vincent, Kai Tisljar, Giulio Disanto, Pascal Benkert, David Leppert, Hans Pargger, Stephan Marsch, Raoul SutterIntensive Care Unit, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.Me, Nils Peters, and Jens Kuhle.
• Intensive Care Unit, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. Sabina.Hunziker@usb.ch.
• Crit Care. 2021 Jan 20; 25 (1): 32.

BackgroundA recent study found serum neurofilament light chain (NfL) levels to be strongly associated with poor neurological outcome in patients after cardiac arrest. Our aim was to confirm these findings in an independent validation study and to investigate whether NfL improves the prognostic value of two cardiac arrest-specific risk scores.MethodsThis prospective, single-center study included 164 consecutive adult after out-of-hospital cardiac arrest (OHCA) patients upon intensive care unit admission. We calculated two clinical risk scores (OHCA, CAHP) and measured NfL on admission within the first 24 h using the single molecule array NF-light® assay. The primary endpoint was neurological outcome at hospital discharge assessed with the cerebral performance category (CPC) score.ResultsPoor neurological outcome (CPC > 3) was found in 60% (98/164) of patients, with 55% (91/164) dying within 30 days of hospitalization. Compared to patients with favorable outcome, NfL was 14-times higher in patients with poor neurological outcome (685 ± 1787 vs. 49 ± 111 pg/mL), with an adjusted odds ratio of 3.4 (95% CI 2.1 to 5.6, p < 0.001) and an area under the curve (AUC) of 0.82. Adding NfL to the clinical risk scores significantly improved discrimination of both the OHCA score (from AUC 0.82 to 0.89, p < 0.001) and CAHP score (from AUC 0.89 to 0.92, p < 0.05). Adding NfL to both scores also resulted in significant improvement in reclassification statistics with a Net Reclassification Index (NRI) of 0.58 (p < 0.001) for OHCA and 0.83 (p < 0.001) for CAHP.ConclusionsAdmission NfL was a strong outcome predictor and significantly improved two clinical risk scores regarding prognostication of neurological outcome in patients after cardiac arrest. When confirmed in future outcome studies, admission NfL should be considered as a standard laboratory measures in the evaluation of OHCA patients.

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