Brain: Neurofilament light chain protein, which can effectively predict the clinical prognosis of subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) leads to increased intracranial pressure, transient cerebral ischemia, and subsequent long-term multifactorial damage, such as neurotoxicity caused by hemoglobin released by thrombus , delayed cerebral ischemia and inflammation.

In order to predict the long-term outcome of such patients, it is necessary to understand the outcome of early brain injury and subsequent pathological events, especially from the perspective of long-term exposure of the brain to hemoglobin and inflammatory molecules.

Clinically, early brain injury can be assessed using the World Federation of Neurosurgical Societies (WFNS) score, which can also partially predict long-term neurological outcomes.
In the largest outcome prediction study to date, many predictive factors were tested, including age, WFNS grade, history of hypertension, Fisher score, aneurysm size, aneurysm location, and treatment.
WFNS can only explain a small part of the variance in the results, and the prediction effects of other predictors are not satisfactory.

We use neurofilament light chain protein (NfL), an intracellular neuronal protein released when neurons are damaged.

NfL also had a profound impact on the results from the 4th day.
In order to link NF-L with SAH-specific pathological processes, they also studied the relationship between NfL and extracellular hemoglobin.
Most CSF hemoglobin does not form a complex with Haptoglobin, but it is said to be able to be bound by exogenous haptoglobin, that is, hemoglobin can be eliminated.
The hemoglobin that can be cleared by CSF can be a good predictor of subsequent CSF NfL.

Then they also studied how NfL flows out of the brain after SAH.
Serum and CSF NF-L are highly correlated.
Compared with the control group, SAH has a lower serum/CSF NF-L ratio, which is consistent with the dysfunction of glucocorticoid excretion after SAH.

The ratio of CSF/serum albumin after SAH increased compared with the control group.

The serum/CSF NF-L ratio is negatively correlated with the CSF/serum albumin ratio, which indicates that the transfer of these two proteins at the blood-brain interface is dissociated.

The important significance of this study lies in the discovery that NfL is a powerful predictor of SAH clinical outcome.
Based on the WFNS score, it has greater significance and can be used as a promising end-point indicator for clinical trials.

Original Source:
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