학술논문
Prognostic performance of blood neurofilament light chain protein in hospitalized COVID-19 patients without major central nervous system manifestations: an individual participant data meta-analysis
Document Type
article
Author
Abdelhak, Ahmed; Barba, Lorenzo; Romoli, Michele; Benkert, Pascal; Conversi, Francesco; D’Anna, Lucio; Masvekar, Ruturaj R; Bielekova, Bibiana; Prudencio, Mercedes; Petrucelli, Leonard; Meschia, James F; Erben, Young; Furlan, Roberto; De Lorenzo, Rebecca; Mandelli, Alessandra; Sutter, Raoul; Hert, Lisa; Epple, Varenka; Marastoni, Damiano; Sellner, Johann; Steinacker, Petra; Aamodt, Anne Hege; Heggelund, Lars; Dyrhol-Riise, Anne Margarita; Virhammar, Johan; Fällmar, David; Rostami, Elham; Kumlien, Eva; Blennow, Kaj; Zetterberg, Henrik; Tumani, Hayrettin; Sacco, Simona; Green, Ari J; Otto, Markus; Kuhle, Jens; Ornello, Raffaele; Foschi, Matteo; Abu-Rumeileh, Samir
Source
Journal of Neurology. 270(7)
Subject
Language
Abstract
Background and aimsTo investigate the prognostic value of blood neurofilament light chain protein (NfL) levels in the acute phase of coronavirus disease 2019 (COVID-19).MethodsWe conducted an individual participant data (IPD) meta-analysis after screening on MEDLINE and Scopus to May 23rd 2022. We included studies with hospitalized adult COVID-19 patients without major COVID-19-associated central nervous system (CNS) manifestations and with a measurement of blood NfL in the acute phase as well as data regarding at least one clinical outcome including intensive care unit (ICU) admission, need of mechanical ventilation (MV) and death. We derived the age-adjusted measures NfL Z scores and conducted mixed-effects modelling to test associations between NfL Z scores and other variables, encompassing clinical outcomes. Summary receiver operating characteristic curves (SROCs) were used to calculate the area under the curve (AUC) for blood NfL.ResultsWe identified 382 records, of which 7 studies were included with a total of 669 hospitalized COVID-19 cases (mean age 66.2 ± 15.0 years, 68.1% males). Median NfL Z score at admission was elevated compared to the age-corrected reference population (2.37, IQR: 1.13-3.06, referring to 99th percentile in healthy controls). NfL Z scores were significantly associated with disease duration and severity. Higher NfL Z scores were associated with a higher likelihood of ICU admission, need of MV, and death. SROCs revealed AUCs of 0.74, 0.80 and 0.71 for mortality, need of MV and ICU admission, respectively.ConclusionsBlood NfL levels were elevated in the acute phase of COVID-19 patients without major CNS manifestations and associated with clinical severity and poor outcome. The marker might ameliorate the performance of prognostic multivariable algorithms in COVID-19.