Longitudinal dynamics of serum neurofilament light chain and prognostic value for functional outcome after acute stroke: a prospective cohort study.
6 affiliations
- 1Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- 2The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- 3The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- 4Clinical Laboratory, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- 5Renji College, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- 6Department of Rehabilitation Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Abstract
Background
Serum neurofilament light chain (sNfL) is a blood biomarker of neuroaxonal injury, but its early longitudinal dynamics and prognostic value in clinically heterogeneous acute stroke populations remain insufficiently defined. This study characterized early sNfL changes and examined their association with functional outcome after acute stroke.Methods
This prospective cohort study consecutively enrolled 104 patients with acute stroke and 86 healthy controls (HCs) between January 2023 and December 2024. Patients were grouped as intracerebral hemorrhage (ICH, n = 28), ischemic stroke treated with intravenous thrombolysis (IS+IVT, n = 33), and ischemic stroke without intravenous thrombolysis (IS-IVT, n = 43). sNfL was measured within 24 h after onset (D1) and on day 7 (D7). Functional outcome was assessed by modified Rankin Scale (mRS) at 3 and 6 months. Linear mixed-effects models assessed longitudinal sNfL trajectories. Multivariable logistic regression assessed prognostic associations, with the 3-month outcome as the primary endpoint and the 6-month outcome as the secondary endpoint. Restricted cubic spline (RCS) and interaction analyses were exploratory.Results
sNfL increased significantly from D1 to D7 (p < 0.001) and was higher in patients with stroke than in HCs at D1 (p < 0.001). In the linear mixed-effects model adjusted for age and admission National Institutes of Health Stroke Scale (NIHSS) score, longitudinal sNfL trajectories did not differ significantly among the clinical stroke groups (time × group interaction, p = 0.225). The predominantly mild-to-moderate severity profile may have limited the detection of trajectory differences. In multivariable logistic regression, each 10-pg/mL increase in D1 sNfL was associated with 5% higher odds of poor functional outcome at 3 months (OR = 1.05; 95% CI, 1.00-1.12; p = 0.047) and 7% higher odds at 6 months (OR = 1.07; 95% CI, 1.01-1.14; p = 0.025). D7 sNfL was not independently associated with poor functional outcome after adjustment. Exploratory RCS analyses found no statistical evidence of nonlinearity for D1 sNfL and suggested a nonlinear association between D7 sNfL and 3-month poor functional outcome.Conclusion
sNfL levels increased during the first week after acute stroke. Higher D1 sNfL was associated with poor functional outcome at 3 and 6 months, suggesting potential value for early prognostic assessment.
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BibTeX
@article{chen2026longitudinal,
title = {{Longitudinal dynamics of serum neurofilament light chain and prognostic value for functional outcome after acute stroke: a prospective cohort study.}},
author = {Guangyong Chen and Yuxin Zhu and Feng Chen and Changhao Zhang and Jin Huang and Weijie Wu and Lei Chen and Lingling Lin and Yueping Chen and Anqi Lin and Qinqin Liu and Peipei Wang and Lidong Zhu and Xuerong Huang},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1932102},
url = {https://europepmc.org/article/MED/42898277},
note = {CC BY},
}
RIS
TY - JOUR
TI - Longitudinal dynamics of serum neurofilament light chain and prognostic value for functional outcome after acute stroke: a prospective cohort study.
AU - Guangyong Chen
AU - Yuxin Zhu
AU - Feng Chen
AU - Changhao Zhang
AU - Jin Huang
AU - Weijie Wu
AU - Lei Chen
AU - Lingling Lin
AU - Yueping Chen
AU - Anqi Lin
AU - Qinqin Liu
AU - Peipei Wang
AU - Lidong Zhu
AU - Xuerong Huang
PY - 2026
DA - 2026/10/05
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1932102
UR - https://europepmc.org/article/MED/42898277
AB - Background Serum neurofilament light chain (sNfL) is a blood biomarker of neuroaxonal injury, but its early longitudinal dynamics and prognostic value in clinically heterogeneous acute stroke populations remain insufficiently defined. This study characterized early sNfL changes and examined their association with functional outcome after acute stroke.Methods This prospective cohort study consecutively enrolled 104 patients with acute stroke and 86 healthy controls (HCs) between January 2023 and December 2024. Patients were grouped as intracerebral hemorrhage (ICH, n = 28), ischemic stroke treated with intravenous thrombolysis (IS+IVT, n = 33), and ischemic stroke without intravenous thrombolysis (IS-IVT, n = 43). sNfL was measured within 24 h after onset (D1) and on day 7 (D7). Functional outcome was assessed by modified Rankin Scale (mRS) at 3 and 6 months. Linear mixed-effects models assessed longitudinal sNfL trajectories. Multivariable logistic regression assessed prognostic associations, with the 3-month outcome as the primary endpoint and the 6-month outcome as the secondary endpoint. Restricted cubic spline (RCS) and interaction analyses were exploratory.Results sNfL increased significantly from D1 to D7 (p < 0.001) and was higher in patients with stroke than in HCs at D1 (p < 0.001). In the linear mixed-effects model adjusted for age and admission National Institutes of Health Stroke Scale (NIHSS) score, longitudinal sNfL trajectories did not differ significantly among the clinical stroke groups (time × group interaction, p = 0.225). The predominantly mild-to-moderate severity profile may have limited the detection of trajectory differences. In multivariable logistic regression, each 10-pg/mL increase in D1 sNfL was associated with 5% higher odds of poor functional outcome at 3 months (OR = 1.05; 95% CI, 1.00-1.12; p = 0.047) and 7% higher odds at 6 months (OR = 1.07; 95% CI, 1.01-1.14; p = 0.025). D7 sNfL was not independently associated with poor functional outcome after adjustment. Exploratory RCS analyses found no statistical evidence of nonlinearity for D1 sNfL and suggested a nonlinear association between D7 sNfL and 3-month poor functional outcome.Conclusion sNfL levels increased during the first week after acute stroke. Higher D1 sNfL was associated with poor functional outcome at 3 and 6 months, suggesting potential value for early prognostic assessment.
SN - 1664-2295
ER -