Trial reportCritical care (London, England)2025
Neurofilament light chain for prognostication after cardiac arrest-first steps towards validation.
Trial report in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03141099 (Blood Pressure and Oxygenation Targets in Post-resuscitation Care, a Randomized Clinical Trial), which is not on this map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Blood Pressure and Oxygenation Targets in Post-resuscitation Care, a Randomized Clinical Trial
Who cites it
2 citing papers in PubMed.
- Effects of remimazolam vs. propofol on plasma neurofilament light chain and postoperative delirium in frail elderly patients undergoing major non-cardiac surgery: a prospective, randomized, assessor-blinded controlled trial.BMC anesthesiology · 2026Trial
- Quantification of blood-based neurovascular unit biomarkers: an analytical platform comparison study.Resuscitation plus · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAfter cardiac arrest, many patients remain comatose, and a substantial proportion do not survive. Neuroprognostication is essential for identifying patients with potential for recovery, and those with severe, irreversible hypoxic-ischemic brain injury. Neurofilament light chain (NfL) is a blood-based marker of neuronal injury that is under evaluation for neuroprognostication. NfL have potential advantages over the currently only guideline recommended blood biomarker for neuroprognostication, neuron-specific enolase, including earlier applicability. However, there is no consensus on optimal NfL cut-off levels. A previous large investigation in OHCA patients, identified NfL thresholds with high specificity for poor outcome, and the purpose of the present investigation is to validate these cutoffs.
methodsThe Blood Pressure and Oxygenation Targets in Post Resuscitation Care (BOX) trial included OHCA patients who were comatose at admission. Patients with at least one plasma biobank sample available at 24-48 h were included in this investigation. NfL was quantified by ELISA. Cerebral performance category score was estimated at 1 year. Diagnostic precision of NfL for prediction of poor neurologic outcome (CPC > 2) was determined by area under the receiver operator curve (AUROC), and the performance of previously identified cut-offs for a specificity of 100% were investigated.
resultsA total of 638 patients had a NfL measurement at either 24 or 48 h. The AUROC for prediction of poor neurologic outcome was 0.95 and 0.95 at 24 and 48 h, respectively. At 24 h, a cut-off of 1232 pg/mL had a specificity of 98%, for prediction of poor neurologic outcome, and false-positive results for 7 patients (1.4%). At 48 h, a cut-off of 1539 pg/ml similarly had a specificity of 98%, and false-positive results for 7 patients (1.3%).
conclusionsThe results of this investigation confirm the prognostic value of NfL for identification of risk of poor neurologic outcome after cardiac arrest. Previously identified cut-offs of 1232 pg/mL at 24 h, and 1539 pg/mL at 48 h, performed excellent with a very high specificity. This indicates that application of NfL will allow for reliable neuroprognostication as early as 24 h after cardiac arrest.
trial registrationClinicalTrials.gov NCT03141099, registered April 30 2017.
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