Clinical Validation of Serum Neurofilament Light as a Biomarker of Traumatic Axonal Injury

摘要 在那些因感染新型冠状病毒SARS-CoV-2而需要住院治疗的人中， 20%的人会发展为需要入住ICU的危重疾病。1 COVID-19 危重病的特征是多器官衰竭，包括急性严重低氧性呼吸道疾病。 衰竭、肾功能不全和血流动力学受损。早期研究表明， 住院病人有神经系统并发症。重症本身与 长期的神经和心理损伤远远超出了最初的侮辱， 即使在急性住院期间也没有明显的脑损伤。这些残疾包括 记忆和认知功能障碍、抑郁症和创伤后应激障碍。这些 症状在ICU入院的幸存者中普遍存在，并且可以持续存在，至少有一种 20-50%的幸存者在出院后一年或更长时间内出现一种或多种症状。那里 我们有理由担心，在COVID-19中幸存的患者可能面临更高的风险， 长时间的住院治疗是常见的，隔离是控制传染所必需的。 在这项研究中，我们的目的是分析神经丝光（NfL），一种急性脑损伤的生物标志物， 患有COVID-19的危重患者。我们将NfL的表达与以下数据相关联： 在急性住院以及长期认知和 心理后果。这项工作的最终目标是确定NfL是否可以早期使用 在住院期间，以确定长期神经和心理疾病风险最高的患者 妥协这将有助于指导管理，因为病人从重症监护环境过渡 康复和恢复。

ABSTRACT In those who require hospitalization due to infection with the novel coronavirus SARS-CoV-2, a syndrome termed COVID-19, 20% develop critical illness requiring ICU admission.1 COVID-19 critical illness is characterized by multiorgan failure, including acute severe hypoxemic respiratory failure, renal dysfunction, and hemodynamic compromise. Early studies indicate that >30% of hospitalized patients have neurological complications. Critical illness itself is associated with prolonged neurological and psychological impairments that extend far beyond the initial insult, even without obvious brain injury during the acute hospitalization. These disabilities include memory and cognitive dysfunction, depression, and post-traumatic stress disorder. These symptoms are prevalent in survivors of ICU admissions and can be persistent, with at least one or more symptom present in 20-50% of survivors a year or more after hospital discharge. There is reason to be concerned that patients who survive COVID-19 may be at even higher risk, given the prolonged hospital course that is common and the isolation required to contain the contagion. In this study, we aim to analyze neurofilment light (NfL), a biomarker of acute brain injury in patients who are critically ill with COVID-19. We will correlate the expression of NfL with data on neurological compromise in the acute hospitalization as well as long-term cognitive and psychological outcomes. The ultimate goal of this work is to determine if NfL can be used early in the hospital stay to identify patients at highest risk of long-term neurological and psychological compromise. This will help guide management as patients transition from the critical care setting to rehabilitation and recovery.