Submitted by: Francisco Gomez, MD
Edited by: Elliot Bodofsky, MD
Martín-Aguilar L, Camps-Renom P, Lleixà C, Pascual-Goñi E, Díaz-Manera J, Rojas-García R, Querol L.
Serum neurofilament light chain predicts long-term prognosis in Guillain-Barré syndrome patients. Journal of Neurology,
Neurosurgery & Psychiatry. 2020. 323899. doi:10.1136.
Summary:
This is presented by the International GBS Outcome Study (IGOS), based in Spain. The neurofilament light (NfL) chain is an increasingly studied biomarker for axonal injury, previously studied in Guillain-Barré syndrome (GBS). This study evaluates it as a prognostic maker in GBS. Enrolling 98 patients in 11 centers, the authors measured serum NfL (sNfl) in 98 patients vs 53 healthy controls. They performed a multivariable regression to correlate sNfL levels with functional outcome at one year.
GBS had higher serum NfL levels (55.49 pg/mL vs 9.83 pg/mL, p<0.0001) and CSF (1308.5 pg/mL vs 440.24 pg/mL, p=0.034) than controls. Patients with preceding diarrhea had higher sNfL than patients with respiratory symptoms or no prior infectious symptoms (134.90 pg/mL vs 47.86 pg/mL vs 38.02 pg/mL, p=0.016). Patients with pure motor variant and Miller Fisher syndrome showed higher sNfL levels than patients with sensorimotor GBS (162.18 pg/mL vs 95.50 pg/mL vs 38.02 pg/mL, p=0.025). Patients with AMAN had higher sNfL levels than other variants (190.55 pg/mL vs 46.79 pg/mL, p=0.013). sNfL returned to normal levels at 1 year. High baseline sNfL levels were associated with inability to run (OR=1.65, 95% CI 1.14 to 2.40, p=0.009) and lower I-RODS (β −2.60, 95% CI −4.66 to −0.54, p=0.014) at 1 year. Cut-off points predicting clinically relevant outcomes at 1 year with high specificity were calculated: inability to walk independently (>319 pg/mL), inability to run (>248 pg/mL) and ability to run (<34 pg/mL).
Comments: An interesting article further wading into the field of biomarkers in neurology. While not necessarily validated or widely applicable, it breaks new ground in the field of GBS neuroprognostication.