Serum neurofilament light chain as outcome marker for intensive care unit patients
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Serum neurofilament light chain as outcome marker for intensive care unit patients Anna Lena Fisse1 · Kalliopi Pitarokoili1 · David Leppert2 · Jeremias Motte1 · Xiomara Pedreiturria1 · Ludwig Kappos2 · Ralf Gold1 · Jens Kuhle2 · Min‑Suk Yoon3 Received: 30 August 2020 / Revised: 13 October 2020 / Accepted: 14 October 2020 © The Author(s) 2020
Abstract Objective Neurofilament 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. Methods Thirty 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. Results NfL 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). Conclusion NfL could be used as a prognostic marker for outcome of ICU patients, especially in patients with impairment of the central nervous system. Keywords Neurofilament · Intensive care unit · Outcome · Critical illness polyneuromyopathy
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]. Through cross-bridging and interconnecting with other components of the cytoskeleton Anna Lena Fisse, Kalliopi Pitarokoili, Jens Kuhle, and Min-Suk Yoon contributed equally to this work. * Anna Lena Fisse [email protected] 1
Department of Neurology, St. Josef‑Hospital, RuhrUniversity Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
2
Departments of Medicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland
3
Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany
(i.e. microtubules and actin filaments), they establish a regionally specialized network that is crucial for proper nerve function [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], but also in disorders of the peripheral nervous system like Guillain–Barré syndrome and chronic inflammatory demyelination neuropathy [5–7]. Blood levels of neurofilaments were shown to monitor and predict progression in these diseases. However, NfL levels are general indicators of neu
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