Prognostic value of early leukocyte fluctuations for recovery from traumatic spinal cord injury

Clinical and Translational Medicine, 2021 · DOI: 10.1002/ctm2.272 · Published: January 13, 2021

Spinal Cord Injury Immunology Research Methodology & Design

Simple Explanation

This study examines the systemic white blood cell (WBC) response to spinal cord injury (SCI) in humans. It investigates how this response is affected by the severity of the trauma, the location of the injury, and the patient's initial neurological condition. The research identifies that a surge in neutrophils (acute neutrophilia) is a negative sign for patient recovery, reducing the chances of improvement in their condition.

Study Duration

5 years (Brisbane cohort, 2012-2017)

Participants

161 SCI patients (Brisbane), 49 SCI patients (Berlin)

Evidence Level

Not specified

Key Findings

1
Acute neutrophilia in SCI patients is correlated with the New Injury Severity Score (NISS) but inversely correlated with neurological outcome (AIS grade).
2
SCI-induced lymphopenia is identified as an independent predictor of better recovery.
3
Acute neutrophilia and increased neutrophil-lymphocyte ratios are significantly associated with respiratory infection presentation.

Research Summary

The study retrospectively analyzed data from 161 SCI patients admitted to Brisbane’s Princess Alexandra Hospital and validated findings with a cohort from the Trauma Hospital Berlin, Germany (n = 49). Logistic regression models were used to assess the strength of links between the WBC response, respiratory infection incidence and neurological outcomes. The findings demonstrate the prognostic value of modeling early circulating neutrophil and lymphocyte counts with patient characteristics for predicting the longer term recovery after SCI.

Practical Implications

Patient Stratification

The multi-factorial models allow for better patient stratification.

Outcome Prediction

The models provide more accurate prediction of patient outcomes.

Therapeutic Targets

Neutrophils remain an important therapeutic target for intervention in acute SCI.

Study Limitations

1
Study design did not include critically ill patients without neurological injury.
2
The study did not include body temperature and medication data in the model.
3
Smaller sample size in the Berlin cohort limited subgroup stratification.

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