背景:神经丝轻链(NfL)是评估心脏骤停(CA)后神经功能的新型生物标志物。尽管荟萃分析已经证实了其预测价值,它没有对其研究进行更详细的分析。我们进行了一项荟萃分析,以评估CA后自主循环恢复患者血清NfL水平与神经系统预后的关系。根据样本采集时间进行亚组分析,评估神经功能的时间,研究设计,是否收到TTM,样品测定方法,以及患者神经系统疾病的存在。分析这些因素对血清NfL预测价值的影响。
方法:已发布Cochrane评论和更新,MEDLINE的扩展搜索,科克伦图书馆,Embase,Scopus,ClinicalKey,CINAHL,和WebofScience在2022年3月之前的相关研究通过纳入和排除标准进行评估.使用随机效应模型或固定效应模型计算标准平均差和95%置信区间,以评估一个可变因子NfL水平与CA患者预后之间的关联。根据样品采集时间进行亚组分析。还使用Egger和Begg检验评估了预后分析和发表偏倚。
结果:在1209篇相关的筛查文章中,6项研究(1360例患者)符合纳入标准,并选择进行荟萃分析。预后良好组(CPC1-2,CPC:脑性能分类评分)血清NfL水平明显低于预后不良组(CPC3-5)SMD(标准化均差)=0.553,95CI(置信区间)=0.418-0.687,I2=65.5%P<0.05。并且在每个采样时间点也存在这种关系(入院时收集NfL标本:SMD:0.48,95CI:0.24-0.73;CA后24小时收集标本:SMD:0.60,95CI:0.32-0.88;CA后48小时获得标本:SMD:0.51,95CI:0.18-0.85;CA后72小时获得标本:SMD:0.59,9538)
结论:NfL可能在心脏骤停后自发循环患者中发挥潜在的神经预后作用,无论CA后何时采集样本.
Neurofilament light chain (NfL) is a novel biomarker for the assessment of neurological function after cardiac arrest (CA). Although meta-analysis has confirmed its predictive value, it has not conducted a more detailed analysis of its research. We conducted a meta-analysis to evaluate the relationship between serum NfL level and neurological prognosis in patients with spontaneous circulation recovery after CA, and subgroup analysis was conducted according to sample collection time, time to assess neurological function, study design, whether TTM was received, the method of specimen determination, and the presence of neurological disease in patients. To analyze the influence of these factors on the predictive value of serum NfL.
Published Cochrane reviews and an updated, extended search of MEDLINE, Cochrane Library, Embase, Scopus, ClinicalKey, CINAHL, and Web of Science for relevant studies until March 2022 were assessed through inclusion and exclusion criteria. The standard mean difference and 95% confidence interval were calculated using the random-effects model or fixed-effects model to assess the association between one variable factor NfL level and the outcome of CA patients. Subgroup analysis according to sample collection time was performed. The prognosis analysis and publication bias were also assessed using Egger\'s and Begg\'s tests.
Among 1209 related articles for screening, 6 studies (1360 patients) met the inclusion criteria and were selected for meta-analysis. The level of serum NfL in the good prognosis group (CPC1-2, CPC: cerebral performance category score) was significantly lower than that in the poor prognosis group (CPC3-5)SMD(standardized mean difference) = 0.553, 95%CI(confidence interval) = 0.418-0.687, I2 = 65.5% P<0.05). And this relationship also exists at each sampling time point (NfL specimens were collected on admission: SMD:0.48,95%CI:0.24-0.73; Samples were collected 24 hours after CA: SMD:0.60,95%CI:0.32-0.88;Specimens were obtained 48 hours after CA: SMD:0.51, 95%CI:0.18-0.85;Specimens were obtained 72 hours after CA: SMD:0.59, 95%CI:0.38-0.81).
NfL may play a potential neuroprognostication role in postcardiac arrest patients with spontaneous circulation, regardless of when the sample was collected after CA.