Comprehensive Summary
This study evaluated serum neurofilament light chain (NFL) as a biomarker for neurological outcome prediction after cardiac arrest. NFL was assessed for its ability to predict neurological outcomes in post-CA patients. A retrospective cohort study was conducted at Charité University Hospital in Berlin, measuring serum NFL between 24 and 96 hours post-CA in 152 patients. This data was compared with other diagnostic mechanisms such as neuron specific enolase (NSE), electroencephalography (EEG), somatosensory evoked potentials (SSEP), and head computed tomography (CT). NFL <55 pg/mL predicted good outcomes (95% specificity, 48% sensitivity), whereas >2000 pg/mL predicted poor outcome (100% specificity, 53% sensitivity). While accuracy was similar to other tests, NFL improved multimodal prognostication by identifying 16-41% additional poor-outcome patients.To conclude, NFL is a highly specific biomarker that performed best on days 2-3 post-CA.
Outcomes and Implications
To avoid premature withdrawal of life sustaining therapy and guide treatment plans, accuracy in neuroprognostication post-CA is necessary. NFL has a remarkable advantage compared to NSE as it has high specificity in poor outcomes as well as fewer extracerebral confounding factors. Adding NFL to existing modalities increased sensitivity, improving detection of irreversible brain injury and potential for recovery. It could prove to be a valuable component to multimodal prognostication methods. Limitations include its single-center design, modest cohort size, incomplete neurological testing in some ECMO patients, and documentation inconsistencies. Whilst further validation is certainly required, NFL in the near future could be promising in daily clinical practice.