Plasma neurofilament light chain level predicts outcomes in stroke patients receiving endovascular thrombectomy

Chih-Hao Chen; Hai-Jui Chu; Yi-Ting Hwang; Yen-Heng Lin; Chung-Wei Lee; Sung-Chun Tang; Jiann-Shing Jeng

doi:10.1186/s12974-021-02254-4

Plasma neurofilament light chain level predicts outcomes in stroke patients receiving endovascular thrombectomy

J Neuroinflammation. 2021 Sep 12;18(1):195. doi: 10.1186/s12974-021-02254-4.

Authors

Chih-Hao Chen^#¹, Hai-Jui Chu^#^{1

2}, Yi-Ting Hwang³, Yen-Heng Lin⁴, Chung-Wei Lee⁵, Sung-Chun Tang⁶, Jiann-Shing Jeng¹

Affiliations

¹ Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan.
³ Department of Statistics, National Taipei University, New Taipei City, Taiwan.
⁴ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan. rad.chungweilee@gmail.com.
⁶ Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. sctang@ntuh.gov.tw.

^# Contributed equally.

Abstract

Background: Timely endovascular thrombectomy (EVT) significantly improves outcomes in patients with acute ischemic stroke (AIS) with large vessel occlusion type. However, whether certain central nervous system-specific plasma biomarkers correlate with the outcomes is unknown. We evaluated the temporal changes and prognostic roles of the levels of these biomarkers in patients with AIS undergoing EVT.

Methods: We enrolled 60 patients who received EVT for AIS and 14 controls. The levels of plasma biomarkers, namely neurofilament light chain (NfL), glial fibrillary astrocytic protein (GFAP), tau, and ubiquitin C-terminal hydrolase L1 (UCHL1), were measured with an ultrasensitive single molecule array before, immediately after, and 24 h after EVT (T1, T2, and T3, respectively). The outcomes of interest were death or disability at 90 days (defined as a modified Rankin Scale score of 3-6) and types of hemorrhagic transformation (hemorrhagic infarction or parenchymal hemorrhage).

Results: Of the 180 blood samples from the 60 patients who received EVT, the plasma NfL, GFAP, and UCHL1 levels at T1 were significantly higher than those of the controls, and the levels of all four biomarkers were significantly higher at T3. Patients with parenchymal hemorrhage had a significantly higher rate of increase in GFAP (P_interaction = 0.005) and UCHL1 (P_interaction = 0.007) levels compared with those without parenchymal hemorrhage. In a multivariable analysis with adjustment for age, sex, National Institute of Health Stroke Scale score, history of atrial fibrillation, and recanalization status, higher NfL levels at T1 (odds ratio [OR] 2.05; 95% confidence interval [CI], 1.03-4.08), T2 (OR, 2.08; 95% CI, 1.05-4.01), and T3 (OR, 3.94; 95% CI, 1.44-10.79) were independent predictors of death or disability at 90 days.

Conclusion: Among patients with AIS who received EVT, those with hemorrhagic transformation exhibited significant increase in plasma GFAP and UCHL1 levels over time. Higher plasma NfL were predictive of unfavorable functional outcomes.

Keywords: Biomarkers; Hemorrhage; Ischemic stroke; Outcome; Thrombectomy.

MeSH terms

Brain Ischemia* / etiology
Brain Ischemia* / surgery
Endovascular Procedures* / adverse effects
Humans
Intermediate Filaments
Ischemic Stroke* / surgery
Stroke* / etiology
Stroke* / surgery
Thrombectomy
Treatment Outcome

Grants and funding

108-S4251/National Taiwan University Hospital