tetano
Editor, Senior Moderator
Ann Clin Transl Neurol
. 2022 Mar 21.
doi: 10.1002/acn3.51542. Online ahead of print.
Prognostic value of serum/plasma neurofilament light chain for COVID-19-associated mortality
Ruturaj R Masvekar[SUP] 1 [/SUP], Peter Kosa[SUP] 1 [/SUP], Kimberly Jin[SUP] 1 [/SUP], Kerry Dobbs[SUP] 1 [/SUP], Michael A Stack[SUP] 1 [/SUP], Riccardo Castagnoli[SUP] 1 [/SUP], Virginia Quaresima[SUP] 2 [/SUP], Helen C Su[SUP] 1 [/SUP], Luisa Imberti[SUP] 2 [/SUP], Luigi D Notarangelo[SUP] 1 [/SUP], Bibiana Bielekova[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: Given the continued spread of coronavirus 2, the early predictors of coronavirus disease 19 (COVID-19) associated mortality might improve patients' outcomes. Increased levels of circulating neurofilament light chain (NfL), a biomarker of neuronal injury, have been observed in severe COVID-19 patients. We investigated whether NfL provides non-redundant clinical value to previously identified predictors of COVID-19 mortality.
Methods: We measured serum or plasma NfL concentrations in a blinded fashion in 3 cohorts totaling 338 COVID-19 patients.
Results: In cohort 1, we found significantly elevated NfL levels only in critically ill COVID-19 patients. Longitudinal cohort 2 data showed that NfL is elevated late in the course of the disease, following the two other prognostic markers of COVID-19: decrease in absolute lymphocyte count (ALC) and increase in lactate dehydrogenase (LDH). Significant correlations between ALC and LDH abnormalities and subsequent rise of NfL implicate that the multi-organ failure is the most likely cause of neuronal injury in severe COVID-19 patients. The addition of NfL to age and gender in cohort 1 significantly improved the accuracy of mortality prediction and these improvements were validated in cohorts 2 and 3.
Interpretation: A substantial increase in serum/plasma NfL reproducibly enhanced COVID-19 mortality prediction. Combined with other prognostic markers, such as ALC and LDH that are routinely measured in ICU patients, NfL measurements might be useful to identify the patients at a high risk of COVID-19-associated mortality, who might still benefit from escalated care.
. 2022 Mar 21.
doi: 10.1002/acn3.51542. Online ahead of print.
Prognostic value of serum/plasma neurofilament light chain for COVID-19-associated mortality
Ruturaj R Masvekar[SUP] 1 [/SUP], Peter Kosa[SUP] 1 [/SUP], Kimberly Jin[SUP] 1 [/SUP], Kerry Dobbs[SUP] 1 [/SUP], Michael A Stack[SUP] 1 [/SUP], Riccardo Castagnoli[SUP] 1 [/SUP], Virginia Quaresima[SUP] 2 [/SUP], Helen C Su[SUP] 1 [/SUP], Luisa Imberti[SUP] 2 [/SUP], Luigi D Notarangelo[SUP] 1 [/SUP], Bibiana Bielekova[SUP] 1 [/SUP]
Affiliations
- PMID: 35313387
- DOI: 10.1002/acn3.51542
Abstract
Objective: Given the continued spread of coronavirus 2, the early predictors of coronavirus disease 19 (COVID-19) associated mortality might improve patients' outcomes. Increased levels of circulating neurofilament light chain (NfL), a biomarker of neuronal injury, have been observed in severe COVID-19 patients. We investigated whether NfL provides non-redundant clinical value to previously identified predictors of COVID-19 mortality.
Methods: We measured serum or plasma NfL concentrations in a blinded fashion in 3 cohorts totaling 338 COVID-19 patients.
Results: In cohort 1, we found significantly elevated NfL levels only in critically ill COVID-19 patients. Longitudinal cohort 2 data showed that NfL is elevated late in the course of the disease, following the two other prognostic markers of COVID-19: decrease in absolute lymphocyte count (ALC) and increase in lactate dehydrogenase (LDH). Significant correlations between ALC and LDH abnormalities and subsequent rise of NfL implicate that the multi-organ failure is the most likely cause of neuronal injury in severe COVID-19 patients. The addition of NfL to age and gender in cohort 1 significantly improved the accuracy of mortality prediction and these improvements were validated in cohorts 2 and 3.
Interpretation: A substantial increase in serum/plasma NfL reproducibly enhanced COVID-19 mortality prediction. Combined with other prognostic markers, such as ALC and LDH that are routinely measured in ICU patients, NfL measurements might be useful to identify the patients at a high risk of COVID-19-associated mortality, who might still benefit from escalated care.