Serum neurofilament light (NfL) outperformed tau, as well as S100B and neuron-specific enolase (NSE), as a blood-based biomarker for the detection of acute sports-related concussion (SRC) in a prospective longitudinal cohort study of professional hockey players published in Neurology.
The investigators sought to compare NfL and tau as blood biomarkers for acute SRC and to establish whether their concentrations at various time points following the injury are linked to prolonged time to return to play (RTP). A total of 288 professional hockey players were followed longitudinally between September 1, 2012 and April 30, 2015. Biomarker analyses and data collection were performed between 2015 and 2017. Serum levels of S100B and NSE were also measured as comparators.
Of the 288 hockey players who were followed, 105 sustained an SRC. Of these individuals, 87 underwent blood tests at 1, 12, 36, and 144 hours following SRC and at the RTP time point. Serum NfL levels at 1, 12, 36, and 144 hours following SRC were associated with prolonged RTP time. Serum NfL concentrations were elevated in players with RTP >10 days vs players with RTP ≤10 days at all time points measured. Of note, serum NfL levels 1 hour following SRC could separate players with RTP >10 days from players with RTP ≤10 days with an area under the receiver operating characteristic curve (AUROC) of 0.82 (P <.0001).
In addition, serum NfL concentrations 144 hours following SRC differentiated players who resigned from the game because of persistent post-concussion symptoms (PCS) from players who returned to play (AUROC, 0.89). Plasma tau levels 1 hour after SRC were also linked to RTP, but less strongly than NfL levels. There were no such associations reported with S100B or NSE.
The investigators concluded that as a biomarker for SRC, NfL outperformed tau, S100B, and NSE. Serum NfL may prove useful from a clinical perspective in identifying individuals at risk for poor recovery and long-term PCS, and may thus help inform decisions regarding when RTP should be considered.
Shahim P, Tegner Y, Marklund N, Blennow K, Zetterberg H. Neurofilament light and tau as blood biomarkers for sports-related concussion [published online April 13, 2018]. Neurology. doi:10.1212/WNL.0000000000005518