Objectives: 

To characterize neurofilament light levels in children who achieved return of spontaneous circulation following cardiac arrest compared with healthy controls and determine an association between neurofilament light levels and clinical outcomes.

Design: 

Retrospective cohort study.

Setting: 

Academic quaternary PICU.

Patients: 

Children with banked plasma samples from an acute respiratory distress syndrome biomarker study who achieved return of spontaneous circulation after a cardiac arrest and healthy controls.

Interventions: 

None.

Measurements and Main Results: 

Neurofilament light levels were determined with a highly sensitive single molecule array digital immunoassay. Patients were categorized into survivors and nonsurvivors and into favorable (Pediatric Cerebral Performance Category score of 1–2 or unchanged from baseline) or unfavorable (Pediatric Cerebral Performance Category score of 3–6 or Pediatric Cerebral Performance Category score change ≥1 from baseline). Associations between neurofilament light level and outcomes were determined using Wilcoxon rank-sum test. We enrolled 32 patients with cardiac arrest and 18 healthy controls. Demographics, severity of illness, and baseline Pediatric Cerebral Performance Category scores were similar between survivors and nonsurvivors. Healthy controls had lower median neurofilament light levels than patients after cardiac arrest (5.5 [interquartile range 5.0–8.2] vs 31.0 [12.0–338.6]; p < 0.001). Neurofilament light levels were higher in nonsurvivors than survivors (78.5 [26.2–509.1] vs 12.4 [10.3–28.2]; p = 0.012) and higher in survivors than healthy controls (p = 0.009). The four patients who survived with a favorable outcome had neurofilament light levels that were not different from patients with unfavorable outcomes (21.9 [8.5––35.7] vs 37.2 [15.4–419.1]; p = 0.60) although two of the four patients who survived with favorable outcomes had progressive encephalopathies with both baseline and postcardiac arrest Pediatric Cerebral Performance Category scores of 4.

Conclusions: 

Neurofilament light is a blood biomarker of hypoxic–ischemic brain injury and may help predict survival and neurologic outcome after pediatric cardiac arrest. Further study in a larger, dedicated cardiac arrest cohort with serial longitudinal measurements is warranted.

中文翻译：

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循环神经丝轻链与小儿心脏骤停后的生存有关。

目标： 

与健康对照组相比，描述心脏骤停后恢复自主循环的儿童的神经丝光水平，并确定神经丝光水平与临床结果之间的关联。

设计： 

回顾性队列研究。

环境： 

学术第四纪PICU。

患者： 

来自急性呼吸窘迫综合征生物标志物研究的储存血浆样本的儿童在心脏骤停和健康对照后实现了自主循环的恢复。

干预： 

没有任何。

测量和主要结果： 

用高度敏感的单分子阵列数字免疫测定法测定神经丝光水平。患者被分为幸存者和非幸存者，并分为有利（儿科大脑表现类别评分为 1-2 或与基线相比没有变化）或不利（儿科大脑表现类别评分为 3-6 或儿科大脑表现类别评分从基线变化≥1）。使用 Wilcoxon 秩和检验确定神经丝光水平与结果之间的关联。我们招募了 32 名心脏骤停患者和 18 名健康对照。幸存者和非幸存者的人口统计学、疾病严重程度和基线儿科脑功能类别评分相似。健康对照组的神经丝中位数较低水平高于心脏骤停后的患者（5.5 [四分位距 5.0–8.2] vs 31.0 [12.0–338.6]；p < 0.001）。非幸存者的神经丝光水平高于幸存者（78.5 [26.2-509.1] vs 12.4 [10.3-28.2]；p = 0.012），幸存者高于健康对照组（p = 0.009）。4 名预后良好的存活患者的神经丝光水平与预后不良的患者没有差异（21.9 [8.5–35.7] vs 37.2 [15.4–419.1]；p = 0.60），尽管存活的 4 名患者中有 2 名具有良好结果的患者患有进行性脑病，基线和心脏骤停后儿科脑性能类别得分均为 4。

结论： 

神经丝光是缺氧缺血性脑损伤的血液生物标志物，可能有助于预测小儿心脏骤停后的存活率和神经系统预后。有必要在更大的、专门的心脏骤停队列中进行进一步的研究，并进行连续纵向测量。