Anne Hege Aamodt1, Einar August Høgestøl2,3, Trine Haug Popperud2, Jan Cato Holter3,4, Anne Ma Dyrhol-Riise3,5, Kristian Tonby3,5, Birgitte Stiksrud5, Else Quist-Paulsen4, Tone Berge6,7, Andreas Barratt-Due8,9, Pål Aukrust3,9,10, Lars Heggelund11,12, Kaj Blennow13,14, Henrik Zetterberg14,15,16, Hanne Flinstad Harbo2,3. 1. Department of Neurology, Oslo University Hospital, Oslo, Norway. a.h.aamodt@medisin.uio.no. 2. Department of Neurology, Oslo University Hospital, Oslo, Norway. 3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 4. Department of Microbiology, Oslo University Hospital, Oslo, Norway. 5. Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway. 6. Department of Mechanical, Electronic and Chemical Engineering, Oslo Metropolitan University, Oslo, Norway. 7. Department of Research, Innovation and Education, Oslo University Hospital, Oslo, Norway. 8. Division of Emergencies and Critical Care, Oslo University HospitalRikshospitalet, Oslo, Norway. 9. Department of Immunology, Oslo University Hospital, Oslo, Norway. 10. Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway. 11. Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. 12. Department of Clinical Science, University of Bergen, Bergen, Norway. 13. Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden. 14. Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden. 15. Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK. 16. UK Dementia Research Institute at UCL, London, UK.
Abstract
OBJECTIVE: To test the hypotheses that blood biomarkers for nervous system injury, serum concentrations of neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAp) can serve as biomarkers for disease severity in COVID-19 patients. METHODS: Forty-seven inpatients with confirmed COVID-19 had blood samples drawn on admission for assessing serum biomarkers of CNS injury by Single molecule array (Simoa), NfL and GFAp. Concentrations of NfL and GFAp were analyzed in relation to symptoms, clinical signs, inflammatory biomarkers and clinical outcomes. We used multivariate linear models to test for differences in biomarker concentrations in the subgroups, accounting for confounding effects. RESULTS: In total, 21% (n = 10) of the patients were admitted to an intensive care unit, and the overall mortality rate was 13% (n = 6). Non-survivors had higher serum concentrations of NfL (p < 0.001) upon admission than patients who were discharged alive both in adjusted analyses (p = 2.6 × 10-7) and unadjusted analyses (p = 0.001). The concentrations of NfL in non-survivors increased over repeated measurements; whereas, the concentrations in survivors were stable. The GFAp concentration was also significantly higher in non-survivors than survivors (p = 0.02). CONCLUSION: Increased concentrations of NfL and GFAp in COVID-19 patients on admission may indicate increased mortality risk. Measurement of blood biomarkers for nervous system injury can be useful to detect and monitor CNS injury in COVID-19.
OBJECTIVE: To test the hypotheses that blood biomarkers for nervous system injury, serum concentrations of neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAp) can serve as biomarkers for disease severity in COVID-19 patients. METHODS: Forty-seven inpatients with confirmed COVID-19 had blood samples drawn on admission for assessing serum biomarkers of CNS injury by Single molecule array (Simoa), NfL and GFAp. Concentrations of NfL and GFAp were analyzed in relation to symptoms, clinical signs, inflammatory biomarkers and clinical outcomes. We used multivariate linear models to test for differences in biomarker concentrations in the subgroups, accounting for confounding effects. RESULTS: In total, 21% (n = 10) of the patients were admitted to an intensive care unit, and the overall mortality rate was 13% (n = 6). Non-survivors had higher serum concentrations of NfL (p < 0.001) upon admission than patients who were discharged alive both in adjusted analyses (p = 2.6 × 10-7) and unadjusted analyses (p = 0.001). The concentrations of NfL in non-survivors increased over repeated measurements; whereas, the concentrations in survivors were stable. The GFAp concentration was also significantly higher in non-survivors than survivors (p = 0.02). CONCLUSION: Increased concentrations of NfL and GFAp in COVID-19 patients on admission may indicate increased mortality risk. Measurement of blood biomarkers for nervous system injury can be useful to detect and monitor CNS injury in COVID-19.
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