Infectious Disease

Elevated serum neurofilament mild ranges point out poorer leads to COVID-19

January 04, 2021

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Elevated serum neurofilament light levels correlated with poor short-term outcomes in patients with COVID-19, as published in Neurology.

The results showed that neural injuries are common and “pronounced” in critically ill patients, the researchers reported.

“Neurological symptoms have been reported in up to 36% of patients with COVID-19,” the researchers wrote. “The light chain of neurofilaments (NfL) is a major component of the neuronal cytoskeleton and plays a role in axonal growth, stability and intracellular transport. Serum NfL (sNfL) is a blood-based marker that specifically reflects neuraxonal damage as shown in studies including acute (ischemic stroke, hypoxic-ischemic encephalopathy) and chronic (MS and cerebral vascular disease) disorders of the [central nervous system]. ”

Raoul Christian Sutter, MD, professor and senior physician for intensive care medicine at the University Hospital Basel in Switzerland, and colleagues used the quantification of the sNfl levels to investigate whether COVID-19 correlates with neuronal damage. The study included all patients who were admitted to the intensive care unit of the University Hospital Basel between March and May 2020 with suspected COVID-19 infection.

Researchers measured sNfL levels in samples from critically ill adult patients with (n = 29) and without (n = 10) COVID-19 obtained within 48 hours of admission to the intensive care unit. They also included serum samples from healthy controls (n = 259; mean age 44.3 years; 31.4% men).

Sutter and colleagues collected information on clinical outcomes like organ failure, delirium, kidney function, complications, and more, as well as demographic data.

The researchers observed lower mean oxygenation and lymphocyte counts during their stay in the intensive care unit in patients with COVID-19, who were also more likely to develop delirium than those without COVID-19. Patients with COVID-19 had prolonged ICU stays and were more likely to develop co-infections and thrombotic events. The study results showed that previous neurological comorbidities were more common in patients without COVID-19 (40%) than in patients with COVID-19 (10.3%).

In the unadjusted analysis, the mean sNfL values ​​did not change significantly between patients with and without COVID-19. However, in the multivariable analysis, the researchers observed sNfL levels that were on average 2.6 times higher in patients with COVID-19 than in those without COVID-19.

Sutter and colleagues found that patients with COVID-19 had mean sNfL levels that were 5.7 times higher than healthy controls (P <0.001), and that 69% of these patients had sNfL levels above the 99th percentile healthy controls compared to only 40% of patients without COVID-19.

According to the results of the study, increased sNfL values ​​correlated with longer stays in the intensive care unit and in the hospital as well as with extended mechanical ventilation. However, after the patient with the highest sNfL value (1,311.7 pg / ml) was excluded, these relationships became less important. The researchers observed higher sNfL levels in patients with unfavorable vs. favorable results (55.9 pg / ml vs. 20 pg / ml; P <0.001). The multivariable model showed a 2.2-fold risk of an unfavorable result per 10 pg / ml increase in sNfL (OR per 10 pg / ml, 2.19; 95% CI, 1.36-4.65) with identical results with the highest sNfL level after patient omission.

The results of the present study “agree well” with data from two other recent studies, one in severe COVID-19 and one in mild to moderate COVID-19, which found elevated NfL levels in patients with COVID-19 compared to healthy patients showed controls according to the study results. While larger studies are needed to confirm Sutter and colleagues’ results, the researchers wrote that the “early and marked rise” in sNfL levels in critically ill patients suggests using sNfL to evaluate treatment effects and identify patients Can be used with a higher risk of neural disease damage and adverse clinical outcomes.

“Our results underscore the general importance of protecting the nervous system from damage in critically ill patients and suggest that sNfL is an early marker to identify patients prone to neurological complications and adverse outcomes,” the researchers wrote.

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