Neurofilament light chain evaluated with a new automated commercially available method for outcome prediction in out-of-hospital cardiac arrest patients.

Abstract

The biomarker neurofilament light (NfL) measured from plasma predicts outcome at 12-72 h after out-of-hospital cardiac arrest (OHCA). We performed a post-hoc analysis of NfL using samples from 112 patients in the COMACARE trial, applying the Siemens Atellica NfL. We analyzed samples collected between 2016 and 2017 using the Siemens Atellica NfL and compared the results with those from the Quanterix Simoa NF-Light-method. We defined poor outcome as Cerebral Performance Category (CPC) 3-5 at six months after OHCA. We evaluated the accuracy of NfL measured at 24-72 h for outcome prediction with high specificity. We calculated the areas under the receiver operating characteristic curves (AUROC) and compared the results of the two methods. The Atellica NfL showed high prognostic performance, with AUROCs (0.97-0.98) comparable to those of the Simoa NfL method with a minimal difference (-0.008-0.001). Tentative cut-off values based on this limited sample size for predicting poor outcome at six months after OHCA with 99 % specificity were 112, 229, and 331 ng/L at 24, 48 and 72 h, respectively. Cut off values for predicting good outcome with 100 % sensitivity were below 29 ng/L at 24, 48, and 72 h. The Atellica NfL assay accuracy appears well comparable to that obtained using the more laborious Simoa method. Further larger studies are needed to determine cut-off values in heterogenous populations of cardiac arrest patients.