Neurofilament light chains to assess sepsis-associated encephalopathy: Are we on the track toward clinical implementation?

Sepsis is the most common cause of admission to intensive care units worldwide. Sepsis patients frequently suffer from sepsis-associated encephalopathy (SAE) reflecting acute brain dysfunction. SAE may result in increased mortality, extended length of hospital stay, and long-term cognitive dysfunction. The diagnosis of SAE is based on clinical assessments, but a valid biomarker to identify and confirm SAE and to assess SAE severity is missing. Several blood-based biomarkers indicating neuronal injury have been evaluated in sepsis and their potential role as early diagnosis and prognostic markers has been studied. Among those, the neuroaxonal injury marker neurofilament light chain (NfL) was identified to potentially serve as a prognostic biomarker for SAE and to predict long-term cognitive impairment. In this review, we summarize the current knowledge of biomarkers, especially NfL, in SAE and discuss a possible future clinical application considering existing limitations.

Automated summary

Sepsis is a common reason for ICU admission worldwide, and sepsis-associated encephalopathy (SAE) is a frequent occurrence in these patients, causing acute brain dysfunction. SAE can lead to increased mortality, longer hospital stays, and lasting cognitive dysfunction. Currently, there is a lack of a valid biomarker for identifying and confirming SAE, as well as assessing its severity. Neurofilament light chain (NfL), a biomarker for neuroaxonal injury, has shown potential as a prognostic biomarker for SAE and for predicting long-term cognitive impairment. This review summarizes the current knowledge on biomarkers, particularly NfL, in SAE, and discusses potential future clinical applications considering existing limitations.