tetano
Editor, Senior Moderator
Eur J Neurol
. 2020 Dec 28.
doi: 10.1111/ene.14703. Online ahead of print.
Biomarkers for CNS injury in CSF are elevated in COVID-19 and associated with neurological symptoms and disease severity
Johan Virhammar[SUP] 1 [/SUP], Anja N??s[SUP] 2 [/SUP], David F?llmar[SUP] 3 [/SUP], Janet L Cunningham[SUP] 4 [/SUP], Andrea Klang[SUP] 5 [/SUP], Nicholas J Ashton[SUP] 6 7 8 9 [/SUP], Sven Jackmann[SUP] 1 [/SUP], Gabriel Westman[SUP] 2 [/SUP], Robert Frithiof[SUP] 10 [/SUP], Kaj Blennow[SUP] 6 11 [/SUP], Henrik Zetterberg[SUP] 6 11 12 13 [/SUP], Eva Kumlien[SUP] 1 [/SUP], Elham Rostami[SUP] 14 [/SUP]
Affiliations
Abstract
Background: Neurological symptoms have been frequently reported in hospitalized patients with coronavirus disease 2019 (COVID-19) and biomarkers of CNS injury are reported to be increased in plasma but not extensively studied in CSF. This study examines CSF for biomarkers of CNS injury and other pathology in relation to neurological symptoms and disease severity in patients with neurological manifestations of COVID-19.
Methods: Nineteen patients with neurological symptoms and mild to critical COVID-19 were prospectively included. Extensive analysis of CSF, including measurement of biomarkers of CNS injury (neurofilament light chain protein (NfL) glial fibrillary acidic protein (GFAp) and total tau) was performed and related to neurological features and disease severity.
Results: Neurological symptoms included altered mental status (42%), headache (42%), central (21%) and peripheral weakness (32%). Two patients demonstrated minor pleocytosis and four patients had increased immunoglobulin G levels in CSF. Neuronal autoantibody testing using commercial tests was negative in all patients. Increased CSF levels of NfL, GFAp and total-tau protein were seen in 63%, 37%, and 16% of patients, respectively. Increased NfL correlated with disease severity, time in intensive care and level of consciousness. NfL in CSF was higher in patients with central neurological symptoms.
Conclusion: Although limited by small sample size, our data suggest that levels of NfL, GFAp and total tau in CSF are commonly elevated in patients with COVID-19 with neurological symptoms. This is in contrast to the standard CSF work-up where pathological findings are scarce. NfL in particular, is associated with central neurological symptoms and disease severity.
. 2020 Dec 28.
doi: 10.1111/ene.14703. Online ahead of print.
Biomarkers for CNS injury in CSF are elevated in COVID-19 and associated with neurological symptoms and disease severity
Johan Virhammar[SUP] 1 [/SUP], Anja N??s[SUP] 2 [/SUP], David F?llmar[SUP] 3 [/SUP], Janet L Cunningham[SUP] 4 [/SUP], Andrea Klang[SUP] 5 [/SUP], Nicholas J Ashton[SUP] 6 7 8 9 [/SUP], Sven Jackmann[SUP] 1 [/SUP], Gabriel Westman[SUP] 2 [/SUP], Robert Frithiof[SUP] 10 [/SUP], Kaj Blennow[SUP] 6 11 [/SUP], Henrik Zetterberg[SUP] 6 11 12 13 [/SUP], Eva Kumlien[SUP] 1 [/SUP], Elham Rostami[SUP] 14 [/SUP]
Affiliations
- PMID: 33369818
- DOI: 10.1111/ene.14703
Abstract
Background: Neurological symptoms have been frequently reported in hospitalized patients with coronavirus disease 2019 (COVID-19) and biomarkers of CNS injury are reported to be increased in plasma but not extensively studied in CSF. This study examines CSF for biomarkers of CNS injury and other pathology in relation to neurological symptoms and disease severity in patients with neurological manifestations of COVID-19.
Methods: Nineteen patients with neurological symptoms and mild to critical COVID-19 were prospectively included. Extensive analysis of CSF, including measurement of biomarkers of CNS injury (neurofilament light chain protein (NfL) glial fibrillary acidic protein (GFAp) and total tau) was performed and related to neurological features and disease severity.
Results: Neurological symptoms included altered mental status (42%), headache (42%), central (21%) and peripheral weakness (32%). Two patients demonstrated minor pleocytosis and four patients had increased immunoglobulin G levels in CSF. Neuronal autoantibody testing using commercial tests was negative in all patients. Increased CSF levels of NfL, GFAp and total-tau protein were seen in 63%, 37%, and 16% of patients, respectively. Increased NfL correlated with disease severity, time in intensive care and level of consciousness. NfL in CSF was higher in patients with central neurological symptoms.
Conclusion: Although limited by small sample size, our data suggest that levels of NfL, GFAp and total tau in CSF are commonly elevated in patients with COVID-19 with neurological symptoms. This is in contrast to the standard CSF work-up where pathological findings are scarce. NfL in particular, is associated with central neurological symptoms and disease severity.