Marcel A Kopp1, Ralf Watzlawick1, Peter Martus1, Vieri Failli1, Felix W Finkenstaedt1, Yuying Chen1, Michael J DeVivo1, Ulrich Dirnagl1, Jan M Schwab2. 1. From the Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (M.A.K., R.W., V.F., F.W.F., J.M.S.), and Center for Stroke Research Berlin (U.D.), Charité-Universitätsmedizin Berlin; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; National Spinal Cord Injury Statistical Center (Y.C., M.J.D.), Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham; Paraplegiology (Spinal Cord Injury Division), Department of Neurology (J.M.S.), and Departments of Neuroscience and Center for Brain and Spinal Cord Repair and Physical Medicine and Rehabilitation, The Neurological Institute (J.M.S.), The Ohio State University, Wexner Medical Center, Columbus. 2. From the Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (M.A.K., R.W., V.F., F.W.F., J.M.S.), and Center for Stroke Research Berlin (U.D.), Charité-Universitätsmedizin Berlin; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; National Spinal Cord Injury Statistical Center (Y.C., M.J.D.), Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham; Paraplegiology (Spinal Cord Injury Division), Department of Neurology (J.M.S.), and Departments of Neuroscience and Center for Brain and Spinal Cord Repair and Physical Medicine and Rehabilitation, The Neurological Institute (J.M.S.), The Ohio State University, Wexner Medical Center, Columbus. Jan.Schwab@osumc.edu.
Abstract
OBJECTIVE: To investigate whether prevalent hospital-acquired pneumonia and wound infection affect the clinical long-term outcome after acute traumatic spinal cord injury (SCI). METHODS: This was a longitudinal cohort study within the prospective multicenter National Spinal Cord Injury Database (Birmingham, Alabama). We screened datasets of 3,834 patients enrolled in 20 trial centers from 1995 to 2005 followed up until 2016. Eligibility criteria were cervical SCI and American Spinal Cord Injury Association impairment scale A, B, and C. Pneumonia or postoperative wound infections (Pn/Wi) acquired during acute medical care/inpatient rehabilitation were analyzed for their association with changes in the motor items of the Functional Independence Measure (FIMmotor) using regression models (primary endpoint 5-year follow-up). Pn/Wi-related mortality was assessed as a secondary endpoint (10-year follow-up). RESULTS: A total of 1,203 patients met the eligibility criteria. During hospitalization, 564 patients (47%) developed Pn/Wi (pneumonia n = 540; postoperative wound infection n = 11; pneumonia and postoperative wound infection n = 13). Adjusted linear mixed models after multiple imputation revealed that Pn/Wi are significantly associated with lower gain in FIMmotor up to 5 years after SCI (-7.4 points, 95% confidence interval [CI] -11.5 to -3.3). Adjusted Cox regression identified Pn/Wi as a highly significant risk factor for death up to 10 years after SCI (hazard ratio 1.65, 95% CI 1.26 to 2.16). CONCLUSION: Hospital-acquired Pn/Wi are predictive of propagated disability and mortality after SCI. Pn/Wi qualify as a potent and targetable outcome-modifying factor. Pn/Wi prevention constitutes a viable strategy to protect functional recovery and reduce mortality. Pn/Wi can be considered as rehabilitation confounders in clinical trials.
OBJECTIVE: To investigate whether prevalent hospital-acquired pneumonia and wound infection affect the clinical long-term outcome after acute traumatic spinal cord injury (SCI). METHODS: This was a longitudinal cohort study within the prospective multicenter National Spinal Cord Injury Database (Birmingham, Alabama). We screened datasets of 3,834 patients enrolled in 20 trial centers from 1995 to 2005 followed up until 2016. Eligibility criteria were cervical SCI and American Spinal Cord Injury Association impairment scale A, B, and C. Pneumonia or postoperative wound infections (Pn/Wi) acquired during acute medical care/inpatient rehabilitation were analyzed for their association with changes in the motor items of the Functional Independence Measure (FIMmotor) using regression models (primary endpoint 5-year follow-up). Pn/Wi-related mortality was assessed as a secondary endpoint (10-year follow-up). RESULTS: A total of 1,203 patients met the eligibility criteria. During hospitalization, 564 patients (47%) developed Pn/Wi (pneumonia n = 540; postoperative wound infection n = 11; pneumonia and postoperative wound infection n = 13). Adjusted linear mixed models after multiple imputation revealed that Pn/Wi are significantly associated with lower gain in FIMmotor up to 5 years after SCI (-7.4 points, 95% confidence interval [CI] -11.5 to -3.3). Adjusted Cox regression identified Pn/Wi as a highly significant risk factor for death up to 10 years after SCI (hazard ratio 1.65, 95% CI 1.26 to 2.16). CONCLUSION: Hospital-acquired Pn/Wi are predictive of propagated disability and mortality after SCI. Pn/Wi qualify as a potent and targetable outcome-modifying factor. Pn/Wi prevention constitutes a viable strategy to protect functional recovery and reduce mortality. Pn/Wi can be considered as rehabilitation confounders in clinical trials.
Authors: Christian Meisel; Jan M Schwab; Konstantin Prass; Andreas Meisel; Ulrich Dirnagl Journal: Nat Rev Neurosci Date: 2005-10 Impact factor: 34.870
Authors: Benedikt Brommer; Odilo Engel; Marcel A Kopp; Ralf Watzlawick; Susanne Müller; Harald Prüss; Yuying Chen; Michael J DeVivo; Felix W Finkenstaedt; Ulrich Dirnagl; Thomas Liebscher; Andreas Meisel; Jan M Schwab Journal: Brain Date: 2016-01-10 Impact factor: 13.501
Authors: Willeke F Westendorp; Jan-Dirk Vermeij; Elles Zock; Imke J Hooijenga; Nyika D Kruyt; Hans J L W Bosboom; Vincent I H Kwa; Martijn Weisfelt; Michel J M Remmers; Robert ten Houten; A H C M Tobien Schreuder; Sarah E Vermeer; Ewout J van Dijk; Diederik W J Dippel; Marcel G W Dijkgraaf; Lodewijk Spanjaard; Marinus Vermeulen; Tom van der Poll; Jan M Prins; Frederique H Vermeij; Yvo B W E M Roos; Ruud P Kleyweg; Henk Kerkhoff; Matthijs C Brouwer; Aeilko H Zwinderman; Diederik van de Beek; Paul J Nederkoorn Journal: Lancet Date: 2015-01-20 Impact factor: 79.321
Authors: Kurt M Lucin; Virginia M Sanders; T Bucky Jones; William B Malarkey; Phillip G Popovich Journal: Exp Neurol Date: 2007-06-02 Impact factor: 5.330
Authors: G Scivoletto; J Bonavita; M Torre; I Baroncini; S Tiberti; E Maietti; L Laurenza; S China; V Corallo; F Guerra; L Buscaroli; C Candeloro; E Brunelli; A Catz; M Molinari Journal: Spinal Cord Date: 2015-09-15 Impact factor: 2.772
Authors: J W Fawcett; A Curt; J D Steeves; W P Coleman; M H Tuszynski; D Lammertse; P F Bartlett; A R Blight; V Dietz; J Ditunno; B H Dobkin; L A Havton; P H Ellaway; M G Fehlings; A Privat; R Grossman; J D Guest; N Kleitman; M Nakamura; M Gaviria; D Short Journal: Spinal Cord Date: 2006-12-19 Impact factor: 2.772
Authors: Freda M Warner; Bobo Tong; Catherine R Jutzeler; Jacquelyn J Cragg; Paulina S Scheuren; John L K Kramer Journal: Neurology Date: 2017-08-15 Impact factor: 9.910
Authors: Marcel A Kopp; Peter Martus; Ralf Watzlawick; Michael J DeVivo; Yuying Chen; Jan M Schwab Journal: Neurology Date: 2018-08-03 Impact factor: 9.910
Authors: Harald Prüss; Andrea Tedeschi; Aude Thiriot; Lydia Lynch; Scott M Loughhead; Susanne Stutte; Irina B Mazo; Marcel A Kopp; Benedikt Brommer; Christian Blex; Laura-Christin Geurtz; Thomas Liebscher; Andreas Niedeggen; Ulrich Dirnagl; Frank Bradke; Magdalena S Volz; Michael J DeVivo; Yuying Chen; Ulrich H von Andrian; Jan M Schwab Journal: Nat Neurosci Date: 2017-09-18 Impact factor: 24.884
Authors: Blessing N R Jaja; Fan Jiang; Jetan H Badhiwala; Ralph Schär; Shekar Kurpad; Robert G Grossman; James S Harrop; Jim D Guest; Elizabeth G Toups; Chris I Shaffrey; Bizhan Aarabi; Max Boakye; Michael G Fehlings; Jefferson R Wilson Journal: J Neurotrauma Date: 2019-06-17 Impact factor: 5.269
Authors: Tom Lübstorf; Marcel A Kopp; Christian Blex; Jan M Schwab; Ulrike Grittner; Thomas Auhuber; Axel Ekkernkamp; Andreas Niedeggen; Erik Prillip; Magdalena Hoppe; Johanna Ludwig; Martin Kreutzträger; Thomas Liebscher Journal: Eur Spine J Date: 2021-09-17 Impact factor: 3.134
Authors: Katherine A Mifflin; Faith H Brennan; Zhen Guan; Kristina A Kigerl; Angela R Filous; Xiaokui Mo; Jan M Schwab; Phillip G Popovich Journal: J Immunol Date: 2022-06-13 Impact factor: 5.426
Authors: Gabrielle E Hatton; Patrick J Mollett; Reginald E Du; Shuyan Wei; Radha Korupolu; Charles E Wade; Sasha D Adams; Lillian S Kao Journal: J Spinal Cord Med Date: 2020-02-11 Impact factor: 1.985