Kopp Marcel A, Finkenstaedt Felix W, Schweizerhof Oliver, Grittner Ulrike, Martus Peter, Watzlawick Ralf, Brienza David, Failli Vieri, Chen Yuying, DeVivo Michael J, Schwab Jan M
Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Berlin Institute of Health, QUEST-Center for Transforming Biomedical Research, Berlin, Germany.
JAMA Netw Open. 2024 Dec 2;7(12):e2444983. doi: 10.1001/jamanetworkopen.2024.44983.
Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair).
To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI.
DESIGN, SETTING, AND PARTICIPANTS: Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024.
PUs acquired during surgical or first rehabilitative SCI care.
The change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression.
The study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01).
In this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.
压疮（PUs）是（1）脊髓损伤（SCI）后常见的继发性并发症，（2）表现为全身炎症水平升高，且（3）可能干扰神经功能恢复（修复不良）的愈合过程。
研究初次住院期间获得的压疮是否与SCI后的神经功能和功能长期转归及生存率相关。
设计、地点和参与者：对前瞻性SCI模型系统（SCIMS）数据库（阿拉巴马州伯明翰）20个中心进行的多中心队列研究。1996年1月至2006年9月纳入急性创伤性颈髓SCI且有相关运动功能障碍（即美国脊髓损伤协会[ASIA]损伤量表[AIS]为A、B和C级）的患者，并随访至2016年6月。2021年4月至2024年9月对数据进行分析。
手术或首次康复性SCI护理期间获得的压疮。
SCI后1年时ASIA运动评分的变化为主要终点。次要终点包括SCI后1年时功能独立性测量（FIM）运动评分的恢复情况以及长达10年的死亡率。采用线性混合模型分析ASIA和FIM运动评分，并对基线神经水平、AIS和社会人口学因素进行随机截距调整。采用Cox回归分析死亡率。
该研究纳入1282例患者，平均（标准差）年龄为38.0（15.7）岁，其中男性患者1028例（80.2%）。关于种族和民族，1249例中有349例（27.9%）为非裔美国患者，1273例中有1139例（89.5%）为非西班牙裔患者，1249例中有834例（66.8%）为白人患者。初次住院期间，594例患者（45.7%）发生压疮。与未发生压疮的患者相比，发生压疮与SCI后1年运动功能恢复受损相关（ASIA运动评分降低9.1分；95%CI，-12.3至-6.0；P＜0.001）。此外，压疮与SCI后1年身体独立性恢复较差相关（FIM运动评分降低8.3分；95%CI：-11.1至-5.5；P＜0.001）。Cox回归证实压疮是SCI后长达10年死亡的风险标志物（风险比，1.41；95%CI，1.09至1.82；P = 0.01）。
在这项队列研究中，SCI后初次住院期间获得的压疮与长期神经功能不良独立相关。压疮是一个可改变的因素，与长期残疾风险增加（恢复的混杂因素）和死亡率升高相关。
