Evaluation of serum neurofilament light in the early management of mTBI patients

Abstract Objectives Serum S100B allows a one-third reduction of computed tomography (CT) scans performed for mild traumatic brain injury (mTBI) patients. In this study, we evaluated the diagnostic performance of serum NF-L in the detection of intracranial lesions induced by mTBI. Methods One hundred seventy-nine adult mTBI patients presenting to the emergency department of Clermont-Ferrand University Hospital with a Glasgow Coma Scale (GCS) score of 14–15 were included. S100B assays were performed for clinical routine while NF-L samples were stored at −80 °C until analysis. CT scans were performed for patients with S100B levels above the decision threshold of 0.10 μg/L. Later, NF-L and S100B levels were compared to CT scan findings to evaluate the biomarkers’ performances. Results The area under the ROC curve (AUC) evaluating the diagnostic ability in the prediction of intracranial lesions was 0.72 (95% CI; 0.58–0.87) for S100B and 0.58 (95% CI; 0.45–0.71) for NF-L, the specificities (at a threshold allowing a 100% sensitivity) were 35.7% for S100B, and 28% for NF-L (p=0.096). AUCs of NF-L and S100B for the identification of patients with neurological disorders were statistically different (p<0.001). The AUCs were 0.87 (95% CI; 0.82–0.93) for NF-L and 0.57 (95% CI; 0.48–0.66) for S100B. There was a poor correlation between NF-L and S100B, and NF-L levels were correlated to patients’ age (Spearman coefficient of 0.79). Conclusions NF-L showed poor performances in the early management of mTBI patients. NF-L levels are strongly correlated to neurodegeneration, whether physiological, age-related, or pathological.