Routinely Measured Hematological Markers Can Help to Predict American Spinal Injury Association Impairment Scale Scores after Spinal Cord Injury

Abstract

Neurological outcomes following spinal cord injury (SCI) are currently difficult to predict. While the initial American Spinal Injury Association Impairment Scale (AIS) grade can give an estimate of outcome, the high remaining degree of uncertainty has stoked recent interest in biomarkers for SCI. This study aimed to assess the prognostic value of routinely measured blood biomarkers by developing prognostic models of AIS scores at discharge and 12 months post-injury. Routine blood and clinical data were collected from SCI patients ( n = 417), and blood measures that had been assessed in less than 50% of patients were excluded. Outcome neurology was obtained from AIS and Spinal Cord Independence Measure III (SCIM-III) scores at discharge and 12 months post-injury, with motor (AIS) and sensory (AIS, touch and prick) abilities being assessed individually. Linear regression models with and without elastic net penalization were created for all outcome measures. Blood measures associated with liver function, such as alanine transaminase, were found to add value to predictions of SCIM-III at discharge and 12 months post-injury. Further, components of a total blood count, including hemoglobin, were found to add value to predictions of AIS motor and sensory scores at discharge and 12 months post-injury. These findings corroborate the results of our previous preliminary study and thus provide further evidence that routine blood measures can add prognostic value in SCI and that markers of liver function are of particular interest.

The potential of prediction models of functioning remains to be fully exploited: A scoping review in the field of spinal cord injury rehabilitation

“…delay to surgery). Only few studies investigated predictors such as blood measures, [59] magnetic resonance imaging, [62] and sensor data [63] . These findings are in line with Wingbermühle et al [66] and Wartenberg et al , [67] which both identified gaps in the investigation of a broad range of possible predictors including biological and physical, as well as psychosocial measures, and especially in the use of directly observable predictors such as imaging, biomarkers, and genetics.…”

“…In total, 2378 articles were retrieved through database searching and after screening the titles and abstracts of 1851 articles and the full-texts of 234 articles, seven eligible studies were identified for inclusion in the scoping review [57][58][59][60][61][62][63] . The corresponding flow diagram of the screening process is presented in Figure 1 .…”

“…With regards to their intended or envisioned use, all prediction models were assigned to the micro system level (e.g. guidance in rehabilitation planning, goal setting and patient care) [57][58][59][60][61][62][63] and some also to the meso system level (e.g. determination of appropriate length of stay, diminishing costs by guided management strategies) [ 60 , 61 ].…”

Investigation of the blood proteome in response to spinal cord injury in rodent models

“…Many clinical and scientific attempts have been made to better diagnose and to develop new treatments to improve the prognosis of individuals following a spinal cord injury (SCI). There is growing evidence that measures of some haematological indices post-injury relate with longer term (12 month) clinical outcome measures in human SCI patients [1,2]. These studies indicate that over-time the 'whole-body', multi-organ response to SCI contributes to long-term clinical outcome and that proteins within the blood can be used to assess this phenomenon [1,2].…”

“…There is growing evidence that measures of some haematological indices post-injury relate with longer term (12 month) clinical outcome measures in human SCI patients [1,2]. These studies indicate that over-time the 'whole-body', multi-organ response to SCI contributes to long-term clinical outcome and that proteins within the blood can be used to assess this phenomenon [1,2]. Therefore a better understanding of the longitudinal protein changes within the blood following a SCI is needed to develop novel interventions [3].…”