Trisha Jogia1, Tom Lübstorf2, Esther Jacobson1, Elissa Scriven3, Sridhar Atresh4,5, Quan H Nguyen6, Thomas Liebscher7, Jan M Schwab2,8,9,10,11,12, Marcel A Kopp2,13, James Walsham5,14, Kate E Campbell5,15, Marc J Ruitenberg1,16. 1. School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 2. Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Germany. 3. Trauma Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 4. Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 5. Princess Alexandra Hospital - Southside Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 6. Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia. 7. Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Germany. 8. Belford Center for Spinal Cord Injury, The Ohio State University, Wexner Medical Center, Columbus, Ohio. 9. Department of Neurology, Spinal Cord Injury Division, The Ohio State University, Wexner Medical Center, Columbus, Ohio. 10. Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, Ohio. 11. Department of Neuroscience, The Ohio State University, Wexner Medical Center, Columbus, Ohio. 12. The Neuroscience Institute, The Ohio State University, Wexner Medical Center, Columbus, Ohio. 13. QUEST - Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany. 14. Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 15. Orthopaedic Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 16. Trauma, Critical Care and Recovery, Brisbane Diamantina Health Partners, Brisbane, Queensland, Australia.
Abstract
BACKGROUND: 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 WBCs, injury characteristics and long-term patient outcomes in individuals with traumatic SCI. METHODS: We 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. RESULTS: We 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. CONCLUSIONS: Our findings demonstrate the prognostic value of modelling early circulating neutrophil and lymphocyte counts with patient characteristics for predicting the longer term recovery after SCI.
BACKGROUND: 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 WBCs, injury characteristics and long-term patient outcomes in individuals with traumatic SCI. METHODS: We 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. RESULTS: We 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. CONCLUSIONS: Our findings demonstrate the prognostic value of modelling early circulating neutrophil and lymphocyte counts with patient characteristics for predicting the longer term recovery after SCI.
Authors: Christopher S Ahuja; Jefferson R Wilson; Satoshi Nori; Mark R N Kotter; Claudia Druschel; Armin Curt; Michael G Fehlings Journal: Nat Rev Dis Primers Date: 2017-04-27 Impact factor: 52.329
Authors: Faith H Brennan; Trisha Jogia; Ellen R Gillespie; Linda V Blomster; Xaria X Li; Bianca Nowlan; Gail M Williams; Esther Jacobson; Geoff W Osborne; Frederic A Meunier; Stephen M Taylor; Kate E Campbell; Kelli Pa MacDonald; Jean-Pierre Levesque; Trent M Woodruff; Marc J Ruitenberg Journal: JCI Insight Date: 2019-05-02
Authors: Jennifer C Fleming; Michael D Norenberg; David A Ramsay; Gregory A Dekaban; Alexander E Marcillo; Alvaro D Saenz; Melissa Pasquale-Styles; W Dalton Dietrich; Lynne C Weaver Journal: Brain Date: 2006-10-28 Impact factor: 13.501
Authors: Dylan A McCreedy; Clare L Abram; Yongmei Hu; Sun Won Min; Madison E Platt; Megan A Kirchhoff; Shelby K Reid; Frank L Jalufka; Clifford A Lowell Journal: J Neuroinflammation Date: 2021-12-24 Impact factor: 8.322