CSF levels of neurofilament is a valuable predictor of long-term outcome after cardiac arrest

Aims: Prognostication of brain damage after cardiac arrest mainly relies on clinical observations. Recently, it has been shown that biochemical markers of brain damage measured in serum aid in this process. In the present study, we wanted to test the usefulness of CSF determinations of a neuronal protein, the neurofilament protein (NFL). Methods and results: Lumbar punctures were performed during week 2 or 3 in 22 patients surviving cardiac arrests. CSF NFL concentrations were analysed using an ELISA. Levels were increased in cardiac arrest patients. Patients with poor outcome according to the Glasgow outcome scale (GOS), low performance at a mini mental state examination (MMSE) and dependent according to Katz at I year follow up had the highest NFL levels. The NFL levels correlated well with anoxia time and coma depth. High positive and negative predictive values, particularly for poor outcome according to GOS were observed. Conclusions: Levels of CSF NFL give a reliable measure of the brain damage following cardiac arrest and the levels are highly predictive of poor outcome. This observation urges the development of sensitive serum assays of this marker to be used in the clinical setting. (C) 2004 Elsevier B.V. All rights reserved.