Gian Marco De Marchis, Mira Katan, Christian Barro, et. al.
European Journal of Neurology
Background and Purpose: Serum Neurofilaments are markers of axonal injury. We addressed their diagnostic and prognostic role in acute ischemic stroke (AIS) and TIA.
Methods: Nested within a prospective cohort study, we compared serum neurofilament light chain levels (sNfL) drawn within 24 hours from symptom onset in patients with AIS or TIA. Patients without MRI on admission were excluded. We assessed if sNfL are associated with: (i) clinical severity on admission, (ii) diagnosis of AIS vs TIA, (iii) infarct size on admission diffusion weighted imaging (MR-DWI), and (iv) functional outcome at 3 months.
Results: We analyzed 504 patients with AIS and 111 patients with TIA. On admission, higher NIHSS scores were associated with higher sNfL: NIHSS<7 (13.1 pg/ml [IQR: 5.3-27.8]), NIHSS 7-15 (IQR: 16.7 pg/ml [7.4-34.9]), NIHSS>15 (21.0 pg/ml [IQR: 9.3-40.4]) (P=0.01). Compared to AIS, patients with TIA had lower sNfL levels (9.0 pg/ml [95%-CI 4.0-19.0] vs. 16.0 pg/ml [95%-CI 7.3-34.4], P<0.001), also after adjusting for age and NIHSS (P=0.006). Among patients with AIS, infarct size on admission MR-DWI was not associated with sNfL, neither in univariate analysis (P=0.15), nor after adjusting for age and NIHSS on admission (P=0.56). Functional outcome three months after stroke was not associated with sNfL after adjusting for established predictors.
Conclusions: In conclusion, among patients admitted within 24 hours of AIS or TIA onset, admission sNfL were associated with clinical severity on admission and TIA diagnosis, but not with infarct size on MR-DWI acquired on admission or functional outcome at three months.