Abstract
Objective: Serum neurofilament light chain (sNfL) is a biomarker for neuroaxonal damage and has been found to be elevated in several neurological diseases with neuronal destruction. New onset of confusion is a hallmark of severity in infections. The objective of this study was to determine whether sNfL levels are increased in patients with community-acquired pneumonia (CAP) and if increased sNfL levels are associated with disease-associated confusion or disease severity. Methods: In this observational study, sNfL levels were determined with single-molecule array technology in CAP patients of the CAPNETZ cohort with validated CRB (confusion, respiratory rate, and blood pressure)-65 score. We determined associations between log-transformed sNfL concentrations, well-defined clinical characteristics, and unfavorable outcome in multivariable analyses. Receiver operating characteristic (ROC) analysis was performed to assess the prediction accuracy of sNfL levels for confusion in CAP patients. Results: sNfL concentrations were evaluated in 150 CAP patients. Patients with confusion had higher sNfL levels as compared to non-confusion patients of comparable overall disease severity. ROC analysis of sNfL and confusion provided an area under the curve (AUC) of 0.73 (95% CI 0.62–0.82). Log-transformed sNfL levels were not associated with general disease severity. In a logistic regression analysis, log2-sNfL was identified as a strong predictor for an unfavorable outcome. Interpretation: sNfL levels are specifically associated with confusion and not with pneumonia disease severity, thus reflecting a potential objective marker for encephalopathy in these patients. Furthermore, sNfL levels are also associated with unfavorable outcome in these patients and might help clinicians to identify patients at risk.
| Original language | English |
|---|---|
| Journal | Annals of Clinical and Translational Neurology |
| Volume | 10 |
| Issue number | 2 |
| Pages (from-to) | 204-212 |
| Number of pages | 9 |
| DOIs | |
| Publication status | Published - 02.2023 |
Funding
This work was supported by the Center for Sepsis Control and Care (Integriertes Forschungs‐ und Behandlungszentrum Sepsis und Sepsisfolgen—Center for Sepsis Control and Care; to H.Y.C., J.W., C.G., R.K., M.P.), the Interdisciplinary Center of Clinical Research of the Medical Faculty Jena (to H.Y.C. and J.W.), the Schilling Foundation (to C.G.) and the BMBF (Fkz: 13N15711) (to M.O). Funding Information We thank Dr. Markus Böhm for his statistical support (Department of Medical Statistics, Computer Science and Data Science, Jena University Hospital). Members of the CAPNETZ study group: M. Dreher, C. Cornelissen (Aachen), W. Knüppel (Bad Arolsen); D. Stolz (Basel, Switzerland); W. Bauer, N. Suttorp, A. Mikolajewska, M. Witzenrath, S. Gläser, D. Thiemig (Berlin); C. Boesecke (Bonn); M. Prediger, S. Schmager (Cottbus); B. Schaaf, J. Kremling, D. Nickoleit-Bitzenberger (Dortmund); M. Kolditz, B. Schulte-Hubbert, S. Langner (Dresden); G. Rohde (Frankfurt), M. Panning (Freiburg); C. Neurohr (Gerlingen); T. Welte, I. Pink, T. Fühner, M. van't Klooster, G. Barten, W. Kröner, F. Eberhardt, O. Unruh, N. Adaskina, T. Illig, N. Klopp (Hannover); M. Pletz (Jena); D. Drömann, P. Parschke, K. Franzen, J. Rupp, N. Käding, F. Waldeck (Lübeck); C. Spinner (Munich); D. Heigener, I. Hering (Rotenburg/Wümme); W. Albrich, M. Seneghini, F. Rassouli, S. Baldesberger (St. Gallen, Switzerland); S. Stenger, M. Wallner (Ulm); H. Burgmann, L. Traby, L. Schubert, R. Chen (Vienna); all study nurses. Open Access funding enabled and organized by Projekt DEAL.
Research Areas and Centers
- Academic Focus: Center for Infection and Inflammation Research (ZIEL)
