Long-term functional outcome in patients with acquired infections after acute spinal cord injury

Kopp, Marcel A.; Watzlawick, Ralf; Martus, Peter; Failli, Vieri; Finkenstaedt, Felix W.; Chen, Yuying; DeVivo, Michael J.; Dirnagl, Ulrich; Schwab, Jan M.

doi:10.1212/wnl.0000000000003652

Cited by 95 publications

(66 citation statements)

References 38 publications

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“…To the author's knowledge, this is the first work that describes the clinical profile of Covid-19 in a cohort of SCI patients. The vulnerability of people with SCI is well known [5][6][7][8][9][10]. We have found that more than half of our patients showed one or two symptoms at the moment of Covid-19 confirmation, which is lower than the symptomatic expression in other published case series [18].…”

Section: Discussionmentioning

confidence: 54%

“…Suppression of the immune system after SCI is due to noradrenergic overactivation and excess glucocorticoid release via hypothalamus-pituitary-adrenal axis stimulation [8] and also to autoimmunity [9]. Both phenomena, respiratory failure and injury-induced immunosuppression, are more pronounced after cervical or high-thoracic compared with low-thoracic SCI level, which explains why pneumonia is the leading cause of mortality in SCI patients [10]. As Covid-19 is a novel viral respiratory infection, its epidemiology and clinical course among people with SCI are yet unknown.…”

Section: Introductionmentioning

confidence: 99%

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Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury

Rodríguez-Cola

Velasco

Gutiérrez-Henares

et al. 2020

Spinal Cord Ser Cases

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Study design Cohort study of patients with spinal cord injury (SCI). Objectives To describe the clinical and analytical features of a coronavirus disease 2019 (Covid-19) infected cohort with SCI to enable accurate diagnosis and to outline prevention measures. Setting This study was conducted at the National Hospital for Paraplegics (Toledo, Spain). Methods A cohort analysis of seven patients with SCI infected by Covid-19 was performed. Diagnosis was confirmed with reverse transcriptase polymerase chain reaction (RT-PCR) of nasal exudate or sputum samples. Clinical, analytical, and radiographic findings were registered.Results RT-PCR detected COVID-19 infection in all patients, affecting males and people with a cervical level of injury more often (five out of seven). The average delay for diagnostic confirmation was 4 days (interquartile range, 1-10). Fever was the most frequent symptom (six out of seven). The second most common symptom was asthenia (four out of seven), followed by dyspnea, cough, and expectoration (three out of seven for each symptom). The Modified Early Warning System score for Covid-19 severity rating was classified as severe in five out of seven cases. All but one patient showed radiological alterations evident in chest X-rays at the time of diagnosis. All patients recovered gradually. Conclusion Our patients with SCI and Covid-19 infection exhibited fewer symptoms than the general population. Furthermore, they presented similar or greater clinical severity. The clinical evolution was not as pronounced as had been expected. This study recommends close supervision of the SCI population to detect early compatible signs and symptoms of Covid-19 infection.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury

Rodríguez-Cola

Velasco

Gutiérrez-Henares

et al. 2020

Spinal Cord Ser Cases

View full text Add to dashboard Cite

show abstract

“…To the author´s knowledge, this is the first work that describes the clinical profile of Covid-19 in a cohort of SCI patients. The vulnerability of people with SCI is well known [6][7][8][9][10][11] . We have found that more than half of our patients showed one or two symptoms at the moment of Covid-19 confirmation, which is lower than the symptomatic expression in other published case series 18 .…”

Section: Discussionmentioning

confidence: 99%

Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury

Gil-Agudo

Rodríguez-Cola

Velasco

et al. 2020

Preprint

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Study design: Cohort study of patients with spinal cord injury (SCI)Objectives: To describe the clinical and analytical features of a Covid-19 infected cohort with SCI to contribute new knowledge for a more accurate diagnosis and to outline prevention measures.Setting: This study was conducted at the National Hospital for Paraplegics (Toledo, Spain).Methods: A cohort analysis of seven patients with SCI infected by Covid-19 was carried out. Diagnosis was confirmed with reverse transcriptase polymerase chain reaction (RT-PCR) of nasal exudate or sputum samples. Clinical, analytical and radiographic findings were registered.Results: RT-PCR detected COVID-19 infection in all patients, affecting males and people with a cervical level of injury more often (5 out 7). The average delay for diagnostic confirmation was 4 days (interquartile range, 1-10). Fever was the most frequent symptom (6 out of 7). The second most common symptom was asthenia (4 out of 7), followed by dyspnea, cough and expectoration (3 out of 7 for each symptom). The MEWS score for Covid-19 severity rating was classified as severe in 5 out of 7. All but one patient showed radiological alterations evident in chest X-Rays at the time of diagnosis. All patients recovered gradually.

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“…2 The aim of this study was to investigate whether infections occurring in an acute care setting after SCI affected long-term functional recovery and survival. 4 METHODS Data source and inclusion criteria. The study by Kopp et al 4 used data gathered from the multicenter National Spinal Cord Injury Database (NSCID).…”

mentioning

confidence: 99%

“…4 METHODS Data source and inclusion criteria. The study by Kopp et al 4 used data gathered from the multicenter National Spinal Cord Injury Database (NSCID). The NSCID prospectively gathers data from 25 specialized traumatic SCI care centers.…”

mentioning

confidence: 99%

Journal Club: Long-term functional outcome in patients with acquired infections after acute spinal cord injury

et al. 2017

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Journal Club: Long-term functional outcome in patients with acquired infections after acute spinal cord injury Infections, particularly pneumonia, are the primary cause of mortality in individuals with spinal cord injury (SCI).1 Several factors may contribute to the high rate of infections in the SCI population, including motor paralysis and reduced reflexes resulting in aspiration, invasive procedures, and so-called SCIinduced immune depression syndrome (SCI-IDS). 2,3SCI-IDS is thought to occur when the connection between the CNS and the immune system are disrupted by a lesion in the spinal cord, resulting in a decrease in immune function.3 In addition to increased morbidity and mortality, infections after SCI may affect neurologic recovery.2,3 A recent study found that infections impaired the return of muscle strength up to 1 year postinjury; however, the long-term consequences remain uncertain. The aim of this study was to investigate whether infections occurring in an acute care setting after SCI affected long-term functional recovery and survival. 4METHODS Data source and inclusion criteria. The study by Kopp et al. 4 used data gathered from the multicenter National Spinal Cord Injury Database (NSCID). The NSCID prospectively gathers data from 25 specialized traumatic SCI care centers. 2Inclusion criteria were admission within 24 hours after injury between 1995 and 2005, age between 17 and 75, a cervical SCI, complete baseline and infection data, and an American Spinal Cord Injury Association Impairment Scale (AIS) grade of A, B, or C (see table e-1 at Neurology.org for a full description of the AIS grading system). Participants were excluded if they resided in a hospital or nursing home prior to injury, had serious concomitant injuries affecting consciousness, or were rehospitalized for unspecified infectious or parasitic diseases during the follow-up period.Exposures and outcomes. The primary outcomes were the motor items of the Functional Independence Measure (FIM; FIM motor total score and 4 additional FIM motor subscores) at 4 timepoints (admission, discharge, 1 year, and 5 years postinjury). The secondary outcome measure was infection-associated mortality at 10 years postinjury. Hospital-acquired infections included pneumonia and postoperative wound infections that occurred during acute care or inpatient rehabilitation.Statistics. FIM motor scores as a dependent variable were analyzed in 3 ways: an explorative analysis of scores at each of the 4 timepoints, a linear mixed model (LMM), and an adjusted LMM. Both models used multiple imputation and a sensitivity analysis using only complete cases. The measure of interest was a time 3 infection interaction term; that is, if early infection had a time-dependent effect on the recovery of FIM motor scores. The LMMs included the initial model (adjusted only for baseline FIM motor scores), an additional model (adjusted for AIS, level of injury, age, ethnic group, and working status), and finally 3 models stratified for AIS grade and adjusted for the aforemen...

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Long-term functional outcome in patients with acquired infections after acute spinal cord injury

Cited by 95 publications

References 38 publications

Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury

Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury

Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury

Journal Club: Long-term functional outcome in patients with acquired infections after acute spinal cord injury

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