Routine Blood Chemistry Predicts Functional Recovery After Traumatic Spinal Cord Injury: A Post Hoc Analysis

Abstract

Background Spinal cord injury (SCI) leads to various degrees of lifelong functional deficits. Most individuals with incomplete SCI experience a certain degree of functional recovery, especially within the first-year postinjury. However, this is difficult to predict, and surrogate biomarkers are urgently needed. Objective We aimed to (1) determine if routine blood chemistry parameters are related to neurological recovery after SCI, (2) evaluate if such parameters could predict functional recovery, and (3) establish cutoff values that could inform clinical decision-making. Methods We performed a post hoc analysis of routine blood chemistry parameters in patients with traumatic SCI (n = 676). Blood samples were collected between 24 and 72 hours as well as at 1, 2, 4, 8, and 52 weeks postinjury. Linear mixed models, regression analysis, and unbiased recursive partitioning (URP) of blood chemistry data were used to relate to and predict walking recovery 1 year postinjury. Results The temporal profile of platelet counts and serum levels of albumin, alkaline phosphatase, and creatinine differentiated patients who recovered walking from those who remained wheelchair bound. The 4 blood chemistry parameters from the sample collection 8 weeks postinjury predicted functional recovery observed 1 year after incomplete SCI. Finally, URP defined a cutoff for serum albumin at 3.7 g/dL, which in combination with baseline injury severity differentiates individuals who regain ambulation from those not able to walk. Specifically, about 80% of those with albumin >3.7 g/dL recovered walking. Conclusions Routine blood chemistry data from the postacute phase, together with baseline injury severity, predict functional outcome after incomplete SCI.

Development of a Systems Medicine Approach to Spinal Cord Injury

“…URP-CTREE has outperformed conventional linear regression in cervical SCI outcome prediction 261 and has been used to generate a pneumonia decision support tool for SCI 266 and to predict walking outcomes based on standard blood chemistry values post-SCI. 267 …”

Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury

“…In a metabolome analysis, CSF levels of citrulline, glycerol, and N-methyl-D-aspartic acid correlated with presenting AIS grade [ 121 ]. It has also been discovered that readily available blood test markers, such as serum albumin, may also be prognostic markers [ 122 ]. Neurophysiological measures are also accessible biomarkers that may correlate in a sensitive manner with neuroplasticity and possibly provide an early indication of therapeutic effects [ 123 ].…”

Peripheral white blood cell responses as emerging biomarkers for patient stratification and prognosis in acute spinal cord injury

“…Possible use of blood products in acute care may require some additional consideration here, as transfusion-related leukocytosis can occur in critically ill patients [52], although that also does not necessarily confound the use of WBC differentials as biomarkers for SCI prognostication. Lastly, incorporating platelet counts and other blood parameters may refine the value of models using systemic WBC responses to predict SCI outcomes [53 ▪ ,54]. The next steps will be to prognostically study WBC types of interest at much greater resolution, aiming to better appreciate their functional roles, capacity and predictive value in relation to SCI recovery.…”