Abstract
Neurological outcomes following spinal cord injury (SCI) are currently difficult to predict. While the initial American Spinal Injury Association Impairment Scale (AIS) grade can give an estimate of outcome, the high remaining degree of uncertainty has stoked recent interest in biomarkers for SCI. This study aimed to assess the prognostic value of routinely measured blood biomarkers by developing prognostic models of AIS scores at discharge and 12 months post-injury. Routine blood and clinical data were collected from SCI patients (n = 417), and blood measures that had been assessed in less than 50% of patients were excluded. Outcome neurology was obtained from AIS and Spinal Cord Independence Measure III (SCIM-III) scores at discharge and 12 months post-injury, with motor (AIS) and sensory (AIS, touch and prick) abilities being assessed individually. Linear regression models with and without elastic net penalization were created for all outcome measures. Blood measures associated with liver function, such as alanine transaminase, were found to add value to predictions of SCIM-III at discharge and 12 months post-injury. Further, components of a total blood count, including hemoglobin, were found to add value to predictions of AIS motor and sensory scores at discharge and 12 months post-injury. These findings corroborate the results of our previous preliminary study and thus provide further evidence that routine blood measures can add prognostic value in SCI and that markers of liver function are of particular interest.
Highlights
Spinal cord injury (SCI) is damage to the spinal cord due to trauma, degeneration, or disease that results in a temporary or permanent change to its neurological function
We have further developed alternative, more robust methods of modeling and have demonstrated that similar markers, including alanine transaminase (ALT) and gamma-glutamyl transferase (GGT) add value when predicting Association Impairment Scale (AIS) scores at discharge and 12 months, and with regard to Spinal Cord Independence Measure (SCIM) outcomes
Routine blood analyses were conducted in the Hematology and Biochemistry department located at the Robert Jones and Agnes Hunt Orthopedic Hospital
Summary
Spinal cord injury (SCI) is damage to the spinal cord due to trauma, degeneration, or disease that results in a temporary or permanent change to its neurological function. The global agestandardized incidence of SCI has been estimated to be 13 per 100,000, whereas the age-standardized prevalence was estimated to be 368 per 100,000.1 With respect to the United Kingdom, it has been estimated that over 1000 new SCIs occur each year, and that 40,000 people are living with SCI.[2] The majority of SCIs have historically been traumatic in nature, most commonly as a result of vehicular accidents, falls, violence, and sports. Non-traumatic SCI, usually as a result of infection or cancer, has been increasing in prevalence.[3,4]. Patients with SCI are often rendered dependent on caregivers and show markedly higher rates of mental illness relative to the general population.[6]
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