Kinetics and Prognostic Value of NeuroFilament Light in Post-cardiac Arrest: A Prospective Multicenter Study

A large majority of patients resuscitated after cardiac arrest (CA) are comatose following the return of spontaneous circulation and require admission to the intensive care unit (ICU). Unfortunately, many of them die during their ICU stay, mainly following the decision to withdraw life-sustaining therapies due to ischemic and hypoxic brain injuries considered irreversible. Early identification of these neurological injury is therefore one of the major challenges for intensivists, in order to tailor the intensity of care.

Currently, the recommended strategy consists of applying a multimodal prognostic approach. This algorithm allows prediction of poor neurological outcome in approximately 50% of cases, according to various studies. This highlights the need for new early prognostic markers to predict both unfavorable and favorable outcomes.

Regarding biomarkers of brain injury, European guidelines recommend the measurement of serum NSE, a biomarker of neuronal injury that is now commonly used. An NSE level > 60 µg/L at 48 and/or 72 hours after cardiac arrest predicts poor neurological outcome with good accuracy (AUC between 0.80 and 0.92 depending on the study), high specificity but limited sensitivity. Moreover, uncertainty remains regarding the optimal threshold value to use, and variable results have been reported across clinical studies. Finally, early serum NSE levels (within the first 24-48 hours) have limited prognostic value, which restricts their usefulness for the early identification of patients likely to have a poor outcome. These limitations have highlighted the need to identify new biomarkers of brain injury to better assess the prognosis of these patients.

Inclusion criteria

• Patients admitted to the ICU for cardiac arrest,
• Patients who regained consciousness following in-hospital or out-of-hospital cardiac arrest,
• Patients in a coma upon arrival in the ICU, defined by a Glasgow Coma Scale (GCS) score <8,
• Patients included in the AfterROSC2 cohort,

Exclusion criteria

• Terminally ill patients (death expected within 3 hours of admission to the ICU),
• Minors,
• Patients under legal guardianship,
• Pregnant women,
• Patients not enrolled in a social security program,
• Prior inclusion in the CINEFIL study,
• Restriction of active therapies prior to the first NFL biomarker assay,
• Objection by a family member or trusted person, if present