Caroline Pouplet1, Gwenhael Colin2, Elie Guichard3, Jean Reignier4, Amélie Le Gouge5, Stéphanie Martin6, Jean-Claude Lacherade7, Jean-Baptiste Lascarrou8. 1. Médecine Intensive Reanimation, District Hospital Center, La Roche-sur-Yon, France. Electronic address: caroline.pouplet@chd-vendee.fr. 2. Médecine Intensive Reanimation, District Hospital Center, La Roche-sur-Yon, France; AfterROSC Network, France. Electronic address: gwenhael.colin@chd-vendee.fr. 3. INSERM CIC1415, CHRU de Tours, Tours, France. Electronic address: elie.guichard@univ-tours.fr. 4. Médecine Intensive Reanimation, University Hospital Center, Nantes, France. Electronic address: jean.reignier@chu-nantes.fr. 5. INSERM CIC1415, CHRU de Tours, Tours, France. Electronic address: amelie.legouge@univ-tours.fr. 6. Médecine Intensive Reanimation, District Hospital Center, La Roche-sur-Yon, France. Electronic address: Stephanie.martin@chd-vendee.fr. 7. Médecine Intensive Reanimation, District Hospital Center, La Roche-sur-Yon, France. Electronic address: Jean-claude.lacherade@chd-vendee.fr. 8. AfterROSC Network, France; Médecine Intensive Reanimation, University Hospital Center, Nantes, France; Paris Cardiovascular Research Center, INSERM U970, Paris, France. Electronic address: jeanbaptiste.lascarrou@chu-nantes.fr.
Abstract
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.
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.
Authors: Chun Song Youn; Kyu Nam Park; Soo Hyun Kim; Byung Kook Lee; Tobias Cronberg; Sang Hoon Oh; Kyung Woon Jeung; In Soo Cho; Seung Pill Choi Journal: Crit Care Date: 2022-04-11 Impact factor: 9.097