Abstract
BackgroundAcute traumatic spinal cord injury (SCI) induces a systemic immune response involving circulating white blood cells (WBCs). How this response is influenced by overall trauma severity, the neurological level of injury and/or correlates with patient outcomes is poorly understood. The objective of this study was to identify relationships between early changes in circulating WBCs, injury characteristics and long‐term patient outcomes in individuals with traumatic SCI.MethodsWe retrospectively analysed data from 161 SCI patients admitted to Brisbane's Princess Alexandra Hospital (exploration cohort). Logistic regression models in conjunction with receiver operating characteristic (ROC) analyses were used to assess the strength of specific links between the WBC response, respiratory infection incidence and neurological outcomes (American Spinal Injury Association Impairment Scale (AIS) grade conversion). An independent validation cohort from the Trauma Hospital Berlin, Germany (n = 49) was then probed to assess the robustness of effects and disentangle centre effects.ResultsWe find that the extent of acute neutrophilia in human SCI patients is positively correlated with New Injury Severity Scores but inversely with the neurological outcome (AIS grade). Multivariate analysis demonstrated that acute SCI‐induced neutrophilia is an independent predictor of AIS grade conversion failure, with an odds ratio (OR) of 4.16 and ROC area under curve (AUC) of 0.82 (P < 0.0001). SCI‐induced lymphopenia was separately identified as an independent predictor of better recovery (OR = 24.15; ROC AUC = 0.85, P < 0.0001). Acute neutrophilia and increased neutrophil‐lymphocyte ratios were otherwise significantly associated with respiratory infection presentation in both patient cohorts.ConclusionsOur findings demonstrate the prognostic value of modelling early circulating neutrophil and lymphocyte counts with patient characteristics for predicting the longer term recovery after SCI.
Highlights
Traumatic spinal cord injury (SCI) is hallmarked by a chronic, non-resolving inflammatory response at the lesion site that involves both CNS-resident and infiltrating white blood cells (WBCs).[1,2] reparative aspects have been ascribed to at least some aspects of inflammation after SCI,[3,4,5] on balance, the inflammatory response is thought to be maladaptive and an amplifier of secondary pathology in spared spinal cord tissue.[6]
A trend towards a greater prevalence of lymphopenia was found in patients with an injury below T6 (P = 0.0601, Figure S3C). These results demonstrate that clinical lymphopenia is present in a subgroup of patients during the first week of SCI and that this phenomenon may be associated with more favourable long-term outcomes in the derivation (i.e. Brisbane) cohort
We found that the neutrophil-lymphocyte ratio at 3 dpi was positively correlated with the length of stay in intensive care unit (ICU) (r2 = 0.1593, P = 0.0073; Figure 5H); a similar albeit weaker association was found for the neutrophil-monocyte ratio at this time point
Summary
Traumatic spinal cord injury (SCI) is hallmarked by a chronic, non-resolving inflammatory response at the lesion site that involves both CNS-resident and infiltrating white blood cells (WBCs).[1,2] reparative aspects have been ascribed to at least some aspects of inflammation after SCI,[3,4,5] on balance, the inflammatory response is thought to be maladaptive and an amplifier of secondary pathology in spared spinal cord tissue.[6]. Acute traumatic spinal cord injury (SCI) induces a systemic immune response involving circulating white blood cells (WBCs) How this response is influenced by overall trauma severity, the neurological level of injury and/or correlates with patient outcomes is poorly understood. The objective of this study was to identify relationships between early changes in circulating
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