Department of Rehabilitation Medicine, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China.
Department of Rehabilitation Medicine, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, Guangdong, China.
CNS Neurosci Ther. 2024 Feb;30(2):e14628. doi: 10.1111/cns.14628.
Neurogenic bladder (NB) is a prevalent and debilitating consequence of spinal cord injury (SCI). Indeed, the accurate prognostication of early bladder outcomes is crucial for patient counseling, rehabilitation goal setting, and personalized intervention planning.
A retrospective exploratory analysis was conducted on a cohort of consecutive SCI patients admitted to a rehabilitation facility in China from May 2016 to December 2022. Demographic, clinical, and electrophysiological data were collected within 40 days post-SCI, with bladder outcomes assessed at 3 months following SCI onset.
The present study enrolled 202 SCI patients with a mean age of 40.3 ± 12.3 years. At 3 months post-SCI, 79 participants exhibited complete bladder emptying. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses identified the H-reflex of the soleus muscle, the American Spinal Injury Association Lower Extremity Motor Score (ASIA-LEMS), and the time from lesion to rehabilitation facility (TLRF) as significant independent predictors for bladder emptying. A scoring system named HALT was developed, yielding a strong discriminatory performance with an area under the receiver operating characteristics curve (aROC) of 0.878 (95% CI: 0.823-0.933). A simplified model utilizing only the H-reflex exhibited excellent discriminatory ability with an aROC of 0.824 (95% CI: 0.766-0.881). Both models demonstrated good calibration via the Hosmer-Lemeshow test and favorable clinical net benefits through decision curve analysis (DCA). In comparison to ASIA-LEMS, both the HALT score and H-reflex showed superior predictive accuracy for bladder outcome. Notably, in individuals with incomplete injuries, the HALT score (aROC = 0.973, 95% CI: 0.940-1.000) and the H-reflex (aROC = 0.888, 95% CI: 0.807-0.970) displayed enhanced performance.
Two reliable models, the HALT score and the H-reflex, were developed to predict bladder outcomes as early as 3 months after SCI onset. Importantly, this study provides hitherto undocumented evidence regarding the predictive significance of the soleus H-reflex in relation to bladder outcomes in SCI patients.
神经原性膀胱（NB）是脊髓损伤（SCI）的一种常见且使人虚弱的后果。事实上，准确预测早期膀胱结局对于患者咨询、康复目标设定和个性化干预计划至关重要。
对 2016 年 5 月至 2022 年 12 月在中国一家康复机构住院的连续 SCI 患者队列进行了回顾性探索性分析。在 SCI 后 40 天内收集了人口统计学、临床和电生理学数据，并在 SCI 发病后 3 个月评估了膀胱结局。
本研究纳入了 202 名平均年龄为 40.3±12.3 岁的 SCI 患者。在 SCI 后 3 个月时，79 名参与者表现出完全排空膀胱。最小绝对收缩和选择算子（LASSO）和多变量逻辑回归分析确定比目鱼肌的 H 反射、美国脊髓损伤协会下肢运动评分（ASIA-LEMS）和从损伤到康复机构的时间（TLRF）是膀胱排空的重要独立预测因子。开发了一种名为 HALT 的评分系统，其受试者工作特征曲线下面积（AUC）为 0.878（95%置信区间：0.823-0.933），具有很强的判别性能。仅使用 H 反射的简化模型表现出出色的判别能力，AUC 为 0.824（95%置信区间：0.766-0.881）。两项模型均通过 Hosmer-Lemeshow 检验进行了良好的校准，并通过决策曲线分析（DCA）显示了有利的临床净收益。与 ASIA-LEMS 相比，HALT 评分和 H 反射均对膀胱结局具有更高的预测准确性。值得注意的是，在不完全损伤的个体中，HALT 评分（AUC=0.973，95%置信区间：0.940-1.000）和 H 反射（AUC=0.888，95%置信区间：0.807-0.970）表现出增强的性能。
开发了两种可靠的模型，HALT 评分和 H 反射，可以在 SCI 发病后 3 个月内预测膀胱结局。重要的是，本研究提供了关于 SCI 患者比目鱼肌 H 反射与膀胱结局之间预测意义的前所未有的证据。
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