Abstract
Objective To test the hypothesis that coronavirus disease 2019 (COVID-19) has an impact on the CNS by measuring plasma biomarkers of CNS injury.
Methods We recruited 47 patients with mild (n = 20), moderate (n = 9), or severe (n = 18) COVID-19 and measured 2 plasma biomarkers of CNS injury by single molecule array, neurofilament light chain protein (NfL; a marker of intra-axonal neuronal injury) and glial fibrillary acidic protein (GFAp; a marker of astrocytic activation/injury), in samples collected at presentation and again in a subset after a mean of 11.4 days. Cross-sectional results were compared with results from 33 age-matched controls derived from an independent cohort.
Results The patients with severe COVID-19 had higher plasma concentrations of GFAp (p = 0.001) and NfL (p < 0.001) than controls, while GFAp was also increased in patients with moderate disease (p = 0.03). In patients with severe disease, an early peak in plasma GFAp decreased on follow-up (p < 0.01), while NfL showed a sustained increase from first to last follow-up (p < 0.01), perhaps reflecting a sequence of early astrocytic response and more delayed axonal injury.
Conclusion We show neurochemical evidence of neuronal injury and glial activation in patients with moderate and severe COVID-19. Further studies are needed to clarify the frequency and nature of COVID-19–related CNS damage and its relation to both clinically defined CNS events such as hypoxic and ischemic events and mechanisms more closely linked to systemic severe acute respiratory syndrome coronavirus 2 infection and consequent immune activation, as well as to evaluate the clinical utility of monitoring plasma NfL and GFAp in the management of this group of patients.
Glossary
- CI=
- confidence interval;
- COVID-19=
- coronavirus disease 2019;
- GFAp=
- glial fibrillary acidic protein;
- ICU=
- intensive care unit;
- IQR=
- interquartile range;
- NfL=
- neurofilament light chain protein;
- RdRP=
- RNA-dependent RNA polymerase;
- SARS-CoV=
- severe acute respiratory syndrome coronavirus;
- SARS-CoV-2=
- severe acute respiratory syndrome coronavirus 2
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received May 5, 2020.
- Accepted in final form June 4, 2020.
- © 2020 American Academy of Neurology
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- Reader response: Neurochemical evidence of astrocytic and neuronal injury commonly found in COVID-19
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