School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Germany.
Clin Transl Med. 2021 Jan;11(1):e272. doi: 10.1002/ctm2.272.
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.
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.
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.
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.
急性创伤性脊髓损伤（SCI）会引起全身免疫反应，涉及循环白细胞（WBC）。这种反应如何受到整体创伤严重程度、损伤神经水平以及/或与患者预后相关的影响，目前了解甚少。本研究的目的是确定创伤性 SCI 患者循环 WBC 早期变化与损伤特征和长期患者预后之间的关系。
我们回顾性分析了来自布里斯班 Princess Alexandra 医院的 161 名 SCI 患者的数据（探索队列）。使用逻辑回归模型结合接收者操作特征（ROC）分析来评估 WBC 反应、呼吸道感染发生率与神经功能结局（美国脊髓损伤协会损伤分级（AIS）转换）之间特定关联的强度。然后，对德国柏林创伤医院的独立验证队列（n=49）进行了研究，以评估效应的稳健性并分解中心效应。
我们发现，人类 SCI 患者急性中性粒细胞增多的程度与新损伤严重程度评分呈正相关，与神经功能结局（AIS 分级）呈负相关。多变量分析表明，急性 SCI 诱导的中性粒细胞增多是 AIS 分级转换失败的独立预测因子，优势比（OR）为 4.16，ROC 曲线下面积（AUC）为 0.82（P<0.0001）。单独确定 SCI 诱导的淋巴细胞减少是更好恢复的独立预测因子（OR=24.15；ROC AUC=0.85，P<0.0001）。在两个患者队列中，急性中性粒细胞增多和中性粒细胞/淋巴细胞比值升高均与呼吸道感染的发生显著相关。
我们的研究结果表明，通过对患者特征进行早期循环中性粒细胞和淋巴细胞计数建模，可预测 SCI 后更长时间的恢复，具有预后价值。
