Early CSF Biomarkers and Late Functional Outcomes in Spinal Cord Injury. A Pilot Study

Although, biomarkers are regarded as an important tool for monitoring injury severity and treatment efficacy, and for predicting clinical evolution in many neurological diseases and disorders including spinal cord injury, there is still a lack of reliable biomarkers for the assessment of clinical course and patient outcome. In this study, a biological dataset of 60 cytokines/chemokines, growth factorsm and intracellular and extracellular matrix proteins, analyzed in CSF within 24 h of injury, was used for correlation analysis with the clinical dataset of the same patients. A heat map was generated of positive and negative correlations between biomarkers and clinical rating scale scores at discharge, and between biomarkers and changes in clinical scores during the observation period. Using very stringent statistical criteria, we found 10 molecules which correlated with clinical scores at discharge, and five molecules, which correlated with changes in clinical scores. The proposed methodology may be useful for generating hypotheses regarding “predictive” and “treatment effectiveness” biomarkers, thereby suggesting potential candidates for disease-modifying therapies using a “bed-to-bench” approach.

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Biomarkers in Traumatic Spinal Cord Injury—Technical and Clinical Considerations: A Systematic Review

Neurorehabilitation and Neural Repair ◽

10.1177/1545968319899920 ◽

2020 ◽

Vol 34 (2) ◽

pp. 95-110 ◽

Cited By ~ 1

Author(s):

Iris Leister ◽

Thomas Haider ◽

Georg Mattiassich ◽

John L. K. Kramer ◽

Lukas D. Linde ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Injury Severity ◽

Data Extraction ◽

Final Analysis ◽

Cochrane Library ◽

Csf Biomarkers ◽

Pilot Studies ◽

Cord Injury

Objective. To examine (1) if serological or cerebrospinal fluid (CSF) biomarkers can be used as diagnostic and/or prognostic tools in patients with spinal cord injury (SCI) and (2) if literature provides recommendations regarding timing and source of biomarker evaluation. Data Sources. A systematic literature search to identify studies reporting on diagnostic and prognostic blood and/or CSF biomarkers in SCI was conducted in PubMed/MEDLINE, CINAHL, Science Direct, The Cochrane Library, ISI Web of Science, and PEDro. Study Selection. Clinical trials, cohort, and pilot studies on patients with traumatic SCI investigating at least one blood or CSF biomarker were included. Following systematic screening, 19 articles were included in the final analysis. PRISMA guidelines were followed to conduct this review. Data Extraction. Independent extraction of articles was completed by 2 authors using predefined inclusion criteria and study quality indicators. Data Synthesis. Nineteen studies published between 2002 and April 2019 with 1596 patients were included in the systematic review. In 14 studies, blood biomarkers were measured, 4 studies investigated CSF biomarkers, and 1 study used both blood and CSF samples. Conclusions. Serum/CSF concentrations of several biomarkers (S100b, IL-6, GFAP, NSE, tau, TNF-α, IL-8, MCP-1, pNF-H, and IP-10) following SCI are highly time dependent and related to injury severity. Future studies need to validate these markers as true biomarkers and should control for secondary complications associated with SCI. A deeper understanding of secondary pathophysiological events after SCI and their effect on biomarker dynamics may improve their clinical significance as surrogate parameters in future clinical studies.

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MR Imaging for Assessing Injury Severity and Prognosis in Acute Traumatic Spinal Cord Injury

Radiologic Clinics of North America ◽

10.1016/j.rcl.2018.09.004 ◽

2019 ◽

Vol 57 (2) ◽

pp. 319-339 ◽

Cited By ~ 13

Author(s):

Jason F. Talbott ◽

John Russell Huie ◽

Adam R. Ferguson ◽

Jacqueline C. Bresnahan ◽

Michael S. Beattie ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Mr Imaging ◽

Injury Severity ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Cervical Spinal Cord Injury Shows Markedly Lower than Predicted Mortality (>72 Hours After Multiple Trauma) From Sepsis and Multiple Organ Failure

Journal of Intensive Care Medicine ◽

10.1177/0885066617753356 ◽

2018 ◽

Vol 35 (4) ◽

pp. 378-382

Author(s):

Oliver Kamp ◽

Oliver Jansen ◽

Rolf Lefering ◽

Renate Meindl ◽

Christian Waydhas ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Trauma ◽

Injury Severity ◽

Multiple Organ ◽

Injury Pattern ◽

Significant Difference ◽

Cord Injury

Background: Sepsis and multiple organ failure (MOF) remain one of the main causes of death after multiple trauma. Trauma- and infection-associated immune reactions play an important role in the pathomechanism of MOF, but the exact pathways remain unknown. Spinal cord injury (SCI) may lead to an altered immune response, and some studies suggest a prognostic advantage for such patients having sepsis or multiple trauma. Yet these findings need to be evaluated in larger cohorts of trauma patients. Methods: Retrospective, multicenter study, using the data of the TraumaRegister DGU. Patients with and without SCI surviving the initial first 72 hours after trauma were matched according to injury pattern and age. Comparative analysis considered morbidity (sepsis, MOF) and hospital mortality. Results: The study population included 800 matched pairs. As intended by the matching process, patients with cervical SCI had an otherwise comparable injury pattern but a higher severity of trauma (mean Injury Severity Score: 36 vs 29, mean number of diagnosis: 5.6 vs 4.4). They had a higher rate of sepsis (15.9% vs 10.9%, P = .005) and MOF (35.9% vs 24.1%, P < .001) while mortality revealed no significant difference (9.5% vs 9.9%, P = .866). Conclusions: Cervical SCI leads to an increased rate of sepsis and MOF but appears to be favorable with respect to outcome of sepsis and MOF following multiple trauma. Further research should focus on the pathomechanisms and the possible arising therapeutic options.

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Activation of SIRT1 by Hyperbaric Oxygenation Promotes Recovery of Motor Dysfunction in Spinal Cord Injury Rats

10.21203/rs.2.23545/v1 ◽

2020 ◽

Author(s):

Huiqiang Chen ◽

Mengyu Yao ◽

Zhibo Li ◽

Ranran Xing ◽

Cheng Zhang ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Molecular Mechanisms ◽

Hyperbaric Oxygenation ◽

Rating Scale ◽

Motor Dysfunction ◽

Sprague Dawley ◽

Inflammatory Cascade ◽

Locomotor Function ◽

Cord Injury

Abstract Background: Emerging evidence demonstrated that hyperbaric oxygenation (HBO) therapy improved the locomotor dysfunction following spinal cord injury (SCI). Sirtuin1(SIRT1) has been characterized as neuroprotection in nerve system. However, whether SIRT1 is involved in alleviation of locomotor function by HBO therapy is unclear. Methods: The Basso, Beattie Bresnahan (BBB) locomotor rating scale was used to evaluate the open-field locomotor function. Western blot, real-time quantitative reverse transcription polymerase chain reaction, SIRT1 activity assay and enzyme-linked immunosorbent assays were performed to explore the molecular mechanisms in adult Sprague-Dawley rats. Results: We found that series HBO therapy significantly improved the locomotor dysfunction and ameliorated the decrease mRNA, protein and activity of spinal cord SIRT1 induced by traumatic SCI injury in rats. In addition, intraperitoneal injection SIRT1 antagonist EX-527 abolished the beneficial effects of series HBO treatment on locomotor deficits and SIRT1 activity loss caused by traumatic SCI injury. However, the rats undergone both series HBO therapy and SIRT1 agonist SRT1720 got the higher BBB score than that undergone series HBO treatment only. Importantly, series HBO treatment following the traumatic SCI injury inhibited the inflammatory cascade and apoptosis-related protein, which was retained by EX-527 and enhanced by SRT1720. Furthermore, EX-527 blocked the enhanced induction of autophagy series with HBO application. Conclusion: These findings demonstrated a new mechanism for series HBO therapy involving activation of SIRT1 and subsequent modulation of inflammatory cascade, apoptosis and autophagy, which contributed to the recovery of motor dysfunction. Key words: HBO, SIRT1, motor dysfunction, inflammation, autophagy, apoptosis

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Intraabdominal Injury is Common in Blunt Trauma Patients who Sustain Spinal Cord Injury

The American Surgeon ◽

10.1177/000313480707301025 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1035-1038

Author(s):

Ali Salim ◽

Marcus Ottochian ◽

Ryan J. Gertz ◽

Carlos Brown ◽

Kenji Inaba ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Length Of Stay ◽

Blunt Trauma ◽

Injury Severity ◽

Unit Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Cord Injury ◽

Intraabdominal Injury

The evaluation of the abdomen in patients with spinal cord injury (SCI) is challenging for obvious reasons. There are very little data on the incidence and complications of patients who sustain SCI with concomitant intraabdominal injury (IAI). To determine the incidence and outcomes of IAI in blunt trauma patients with SCI, a trauma registry and record review was performed between January 1998 and December 2005. Baseline demographic data, Injury Severity Score, and associated IAI were collected. Two groups were established and outcomes were analyzed based on the presence or absence of IAI. Intraabdominal and hollow viscus injures were found in 15 per cent and 6 per cent, respectively, of 292 patients with blunt SCI. The presence of intraabdominal injury varied according to the level of the SCI: 10 per cent of cervical, 23 per cent of thoracic, and 18 per cent of lumbar SCI. The overall mortality was 16 per cent. The presence of intraabdominal injury was associated with longer intensive care unit length of stay (13 versus 6 days, P < 0.01), hospital length of stay (23 versus 18 days, P < 0.05), higher complication rate (46% versus 33%, P = 0.09), and higher mortality (44% versus 11%, P < 0.01) when compared with patients with SCI without IAI. Intraabdominal injuries are common in blunt SCI. Liberal evaluation with computed tomography is necessary to identify injuries early.

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Coordination of the Bladder Detrusor and the External Urethral Sphincter in a Rat Model of Spinal Cord Injury: Effect of Injury Severity

Journal of Neuroscience ◽

10.1523/jneurosci.21-02-00559.2001 ◽

2001 ◽

Vol 21 (2) ◽

pp. 559-569 ◽

Cited By ~ 77

Author(s):

Victor Pikov ◽

Jean R. Wrathall

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Rat Model ◽

Injury Severity ◽

Urethral Sphincter ◽

External Urethral Sphincter ◽

Cord Injury ◽

Bladder Detrusor

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F.01 Prognostic factors in adults with spinal cord injury without radiological abnormalities (SCIWORA): MRI study

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.96 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S18-S19

Author(s):

R Martinez-Perez ◽

I Paredes ◽

J Cotrina ◽

S Pandey ◽

A Lagares

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Prognostic Factors ◽

Injury Severity ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Lesion Length ◽

Initial Examination ◽

Severity Of Injury ◽

Cord Injury

Background: Spinal Cord Injury Without Radiological Abnormality (SCIWORA) is underreported and poorly recognized in adults. This entity is an important subtype of spinal cord injury (SCI) with relatively good outcomes. Despite this, few studies have been performed to determine specific imaging-related prognostic factors. Methods: A retrospective review of adult patients with cervical SCI admitted to two University hospitals from January 2000 to December 2010 was performed. Only patients with an MRI performed within 72 hours after trauma were included. All patients with bony injury or traumatic malalignment were excluded. Data gathered on the remaining patients included demographics, mechanism of injury, severity of SCI, long-term patient outcome, improvement in neurological condition and MRI results. Results: 49 patients selected. Patients with extramedullary hemorrhage showed worse neurological status at initial examination. Disruption of either the anterior longitudinal ligament or ligamentum flavum was associated with worse outcomes at initial examination and at 1-year follow up. Lesion length was also significantly associated with outcomes at 1 year evaluation and initial evaluation. Conclusions: Early MRI has an important prognostic value in patients suffering SCIWORA. Lesion length is a powerful predictor of outcome. Soft tissue injury and spinal cord changes play a role in the severity of injury as well as the ability to recover.

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