title: Serial soluble neurofilament heavy chain in plasma as a marker of brain injury after cardiac arrest.
abstract: BACKGROUND
  Induced hypothermia has been shown to improve outcome after cardiac arrest, but early prognostication is hampered by the need for sedation. Here we tested whether a biomarker for neurodegeneration, the neurofilament heavy chain (NfH), may improve diagnostic accuracy in the first days after cardiac arrest.
  
  
  METHODS
  This prospective study included 90 consecutive patients treated with hypothermia after cardiac arrest. Plasma levels of phosphorylated NfH (SMI35) were quantified using standard ELISA over a period of 72 h after cardiac arrest. The primary outcome was the dichotomized Cerebral Performance Categories scale (CPC). A best CPC 1-2 during 6 months follow-up was considered a good outcome, a best CPC of 3-4 a poor outcome. Receiver operator characteristics and area under the curve were calculated.
  
  
  RESULTS
  The median age of the patients was 65 years, and 63 (70%) were male. A cardiac aetiology was identified in 62 cases (69%). 77 patients (86%) had out-of-hospital cardiac arrest. The outcome was good in 48 and poor in 42 patients. Plasma NfH levels were significantly higher 2 and 36 hours after cardiac arrest in patients with poor outcome (median 0.28 ng/mL and 0.5 ng/mL, respectively) compared to those with good outcome (0 ng/mL, p = 0.016, p < 0.005, respectively). The respective AUC were 0.72 and 0.71.
  
  
  CONCLUSIONS
  Plasma NfH levels correlate to neurological prognosis following cardiac arrest. In this study, 15 patients had neurological co-morbidities and there was a considerable overlap of data. As such, neurofilament should not be used for routine neuroprognostication until more data are available.
authors.affiliation: Department of Intensive-and Perioperative Care, Skåne University Hospital, Department of Clinical Sciences Lund University, Lund, Sweden. malin.rundgren@skane.se
authors.forename: Malin
authors.initials: M
authors.lastname: Rundgren
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
authors.forename: Tobias
authors.initials: T
authors.lastname: Cronberg
authors.forename: Bertil
authors.initials: B
authors.lastname: Romner
authors.forename: Axel
authors.initials: A
authors.lastname: Petzold
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D016900:Neurofilament Proteins / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016900:Neurofilament Proteins