Journal Article

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

Kopp, Marcel A., Nguyen, Quan H., Schwab, Jan M., Atresh, Sridhar, Jacobson, Esther, Liebscher, Thomas, Walsham, James, Lübstorf, Tom, Ruitenberg, Marc J., Jogia, Trisha, Scriven, Elissa, Campbell, Kate E.

2021

Overview

Background 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. Methods 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. Results 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. Conclusions 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. We describe the systemic white blood cell (WBC) response to human spinal cord injury (SCI) and demonstrate how this is influenced by overall trauma severity, lesion level, and neurological grade on admission. We identify acute neutrophilia as a negative predictor for patient outcomes, the occurrence of which reduces the likelihood of American Spinal Injury Association Impairment Scale (AIS) grade conversion. We further show that lymphopenia during the first week of SCI is typically associated with better recovery, but that higher neutrophil to lymphocyte ratios early after SCI are associated with infection presentation in at‐risk patients. Collectively, the multi‐factorial models described in this work allow for better patient stratification and more accurate prediction of their outcomes.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: acute phase response / Adolescent / Adult / Age / Aged / Aged, 80 and over / Berlin / Blood / Body mass index / Clinical medicine / Cohort Studies / Female / Humans / immune depression syndrome / Injury Severity Score / Length of stay / Leukocyte Disorders - complications / Leukocyte Disorders - immunology / Leukocytes - immunology / lymphocytes / Male / Medical prognosis / Middle Aged / monocytes / neurotrauma / neutrophils / Nosocomial infections / Patients / pneumonia / Prognosis / Recovery of Function - immunology / Research ethics / Retrospective Studies / Spinal cord injuries / Spinal Cord Injuries - complications / Spinal Cord Injuries - immunology / Trauma / Vertebrae / Young Adult