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What’s the best brain-injury biomarker after cardiac arrest?

JAMA Neurology
Reuters Health - 03/03/2022 - When it comes to blood-based brain injury biomarkers, neurofilament light (Nf-L) chain showed the highest accuracy in predicting unfavorable neurologic outcome in patients with a hypoxic ischemic brain injury after cardiac arrest in a meta-analytic review. 

"Brain injury biomarkers released into circulation from the injured neurovascular unit are important prognostic tools in patients with cardiac arrest who develop hypoxic ischemic brain injury (HIBI) after return of spontaneous circulation (ROSC)," the authors note in JAMA Neurology. 

Dr. Mypinder S. Sekhorn of Vancouver General Hospital, in Canada, and colleagues pooled data from 86 studies with 10,567 patients that investigated the neuroprognostic utility of blood-based brain-injury biomarkers in patients with cardiac arrest with HIBI. 

The biomarkers were neuron-specific enolase (NSE), S100 calcium-binding protein beta (S100-beta), glial fibrillary acidic protein (GFAP), Nf-L, tau and ubiquitin carboxyl hydrolase L1 (UCH-L1). 

Biomarker analysis at 48 hours after ROSC showed that Nf-L had the highest predictive value for unfavorable neurologic outcome, with an area under the curve of 0.92 (95% CI, 0.84 to 0.97). 

Subgroup analyses of patients treated with targeted temperature management and those who specifically suffered an out-of-hospital cardiac arrest showed similar results, the researchers report. 

Subcortical white matter is increasingly recognized as a major anatomical site of HIBI associated with unfavorable neurologic outcome, they point out. A recent study found that white matter injury on magnetic resonance imaging was the strongest predictor of unfavorable neurologic outcome. 

Dr. Sekhorn and colleagues say their results "corroborate these findings in that Nf-L, a biomarker reflective of axonal injury, was the most accurate in determining unfavorable neurologic outcome." 

They note that tau, which also reflects axonal injury, had greater diagnostic accuracy compared with NSE or S100-beta, but was less diagnostically accurate compared with Nf-L, "which may be explained by extracerebral sources during global ischemia-reperfusion." 

Summing up, they say while their results are "promising, and the included studies are of overall strong methodologic design, they are tempered by the relative paucity of prospective studies investigating Nf-L. Prospective and blinded studies with standardized bio-specimen collection as well as analytical methods are needed in this field," they conclude. 

The study had no specific funding and the authors have no relevant disclosures. 

SOURCE: https://bit.ly/3tnKfGK JAMA Neurology, online February 28, 2022. 

By Reuters Staff 

© 2023 The Author(s). Published by Medicom Medical Publishers.
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