• Homeyra Labib, Maud A Tjerkstra, Charlotte E Teunissen, Janneke Horn, Lisa Vermunt, Bert A Coert, Rene Post, William P Vandertop, and Dagmar Verbaan.
• Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Neurovascular Disorders, Amsterdam Neurosciences, Amsterdam, the Netherlands. Electronic address: h.labib@amsterdamumc.nl.
• World Neurosurg. 2024 Sep 1; 189: e238e252e238-e252.

BackgroundNeurofilament light chain (NfL), a biomarker reflecting neuro-axonal damage, may be useful in improving clinical outcome prediction after aneurysmal subarachnoid hemorrhage (aSAH). We explore the robust and additional value of NfL to neurologic and radiologic grading scales in predicting poor outcome after aSAH.MethodsIn this prospective cohort study conducted in a single tertiary center, blood samples were collected of aSAH patients within 24 hours after ictus and before endovascular/surgical intervention. The primary endpoint was poor outcome at 6 months' follow-up. Receiver operating curves (ROC), area under the curve (AUC, 95% CI) and model-fit (Nagelkerke R2) were calculated for NfL, neurologic grading scale (WFNS), modified Fisher, age ,and sex. A combined ROC and AUC were calculated for variables with an AUC ≥ 0.70.ResultsA total of 66 (42%) had poor outcome. The AUC of NfL for poor outcome was 0.70 (0.62-0.78). Combining NfL and WFNS resulted in a slightly higher model fit and not-significantly higher AUC for predicting poor outcome (R2 0.51; AUC 0.86, 0.80-0.92) compared with WFNS alone. When patients were stratified according to hemorrhage severity, median NfL [IQR] levels were significantly higher in poor grade (14 [7-32] pg/mL) than good grade patients (7 [5-14] pg/mL). Within poor grade patients, median NfL [IQR] levels were significantly higher in non-survivors (19 [11-36] pg/mL) than survivors (7 [6-13] pg/mL).ConclusionIn the entire aSAH cohort, plasma NfL has an acceptable predictive performance but does not improve clinical outcome prediction. However, NfL may have potential value in subgroups based on hemorrhage severity.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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