Purpose

In current guidelines, neurological prognostication after cardiopulmonary resuscitation is based on a multimodal approach bundled in algorithms. Biomarkers are of particular interest because they are unaffected by interpretation bias. We assessed the predictive value of serum neurofilament light chains (NF-L) in patients with a shockable rhythm who received cardiopulmonary resuscitation, and evaluated the predictive value of a modified algorithm where NF-L dosage is included.

Methods

All patients who were included participated in the randomized ISOCRATE trial. NF-L values 48 h after ROSC were compared for patients with a good (Cerebral Performance Category (CPC) 1 or 2) and a poor prognosis (CPC 3 to 5 or death). The benefit of adding NF-L dosage to the current guideline algorithm was then assessed for NF-L thresholds of 500 and 1,200 pg/ml as previously described.

Results

NF-L was assayed for 49 patients. In patients with good versus those with poor outcomes, median NF-L values at 48 h were 72 ± 78 and 7,755 ± 9,501 pg/ml respectively (P < 0.0001; AUC [95 %CI] = 0.87 [0.74;0.99]). The sensitivity of the modified ESICM/ERC 2021 algorithm after adding NF-L with thresholds of 500 and 1,200 pg/ml was 0.74 (CI 95% 0.51–0.88) and 0.68 (CI 95% 0.46–0.86), respectively, versus 0.53 (CI 95% 0.32–0.73) for the unmodified algorithm. In three instances the specificity was 1.

Conclusion

High NF-L plasma levels 48 h after cardiac arrest was significantly associated with a poor outcome. Adjunction to the current guideline algorithm of an NF-L assay with a 500 pg/ml threshold 48 h after cardiac arrest provided the best sensitivity compared to the algorithm alone, while specificity remained excellent.

中文翻译：

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各种神经预后算法的准确性和神经丝轻链剂量对可电击心脏骤停复苏患者的附加价值：ISOCRATE 研究的辅助分析

目的

在目前的指南中，心肺复苏后的神经系统预后基于算法中捆绑的多模式方法。生物标志物特别受关注，因为它们不受解释偏差的影响。我们评估了血清神经丝轻链 (NF-L) 在接受心肺复苏的可电击节律患者中的预测价值，并评估了包含 NF-L 剂量的改进算法的预测价值。

方法

纳入的所有患者都参加了随机 ISOCRATE 试验。将 ROSC 后 48 小时的 NF-L 值与预后良好（脑功能分类 (CPC) 1 或 2）和预后不良（CPC 3 至 5 或死亡）的患者进行比较。然后如前所述针对 500 和 1,200 pg/ml 的 NF-L 阈值评估在当前指南算法中添加 NF-L 剂量的益处。

结果

对 49 名患者进行了 NF-L 检测。在预后良好和不良的患者中，48 小时时的中位 NF-L 值分别为 72 ± 78 和 7,755 ± 9,501 pg/ml（P < 0.0001；AUC [95 %CI] = 0.87 [0.74；0.99]）。添加阈值为 500 和 1,200 pg/ml 的 NF-L 后，改进的 ESICM/ERC 2021 算法的灵敏度分别为 0.74（CI 95% 0.51–0.88）和 0.68（CI 95% 0.46–0.86），而 0.53（对于未修改的算法，CI 95% 0.32–0.73)。在三个实例中，特异性为 1。

结论

心脏骤停后 48 小时的高 NF-L 血浆水平与不良预后显着相关。与单独的算法相比，在心脏骤停后 48 小时以 500 pg/ml 阈值为 500 pg/ml 阈值的 NF-L 检测的当前指南算法的附加提供了最佳的灵敏度，而特异性仍然很好。