Kopp Marcel A, Watzlawick Ralf, Martus Peter, Failli Vieri, Finkenstaedt Felix W, Chen Yuying, DeVivo Michael J, Dirnagl Ulrich, Schwab Jan M
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.
Neurology. 2017 Feb 28;88(9):892-900. doi: 10.1212/WNL.0000000000003652. Epub 2017 Jan 27.
To investigate whether prevalent hospital-acquired pneumonia and wound infection affect the clinical long-term outcome after acute traumatic spinal cord injury (SCI).
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 (FIM) using regression models (primary endpoint 5-year follow-up). Pn/Wi-related mortality was assessed as a secondary endpoint (10-year follow-up).
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 FIM 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).
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.
探讨医院获得性肺炎和伤口感染是否会影响急性创伤性脊髓损伤（SCI）后的临床长期预后。
这是一项在前瞻性多中心国家脊髓损伤数据库（阿拉巴马州伯明翰）内进行的纵向队列研究。我们筛选了1995年至2005年在20个试验中心登记的3834例患者的数据集，随访至2016年。纳入标准为颈髓损伤以及美国脊髓损伤协会损伤分级为A、B和C级。分析急性医疗/住院康复期间获得的肺炎或术后伤口感染（Pn/Wi）与功能独立性测量（FIM）运动项目变化之间的关联，采用回归模型（主要终点为5年随访）。将Pn/Wi相关死亡率评估为次要终点（10年随访）。
共有1203例患者符合纳入标准。住院期间，564例患者（47%）发生Pn/Wi（肺炎540例；术后伤口感染11例；肺炎合并术后伤口感染13例）。多次插补后的校正线性混合模型显示，Pn/Wi与SCI后长达5年的FIM增益显著降低相关（-7.4分，95%置信区间[CI] -11.5至-3.3）。校正后的Cox回归确定Pn/Wi是SCI后长达10年死亡的高度显著危险因素（风险比1.65，95%CI 1.26至2.16）。
医院获得性Pn/Wi可预测SCI后的残疾进展和死亡率。Pn/Wi是一个有效的且可针对的改善预后因素。预防Pn/Wi是保护功能恢复和降低死亡率的可行策略。在临床试验中，Pn/Wi可被视为康复混杂因素。
