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

Aim Of The Study: 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.

Methods: 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.

Results: 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.

Conclusion: 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.