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

Abstract

Background: Acute traumatic spinal cord injury (SCI) induces a systemic immune response involving circulating white blood cells (WBC). 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 n=161 SCI patients admitted to Brisbanes Princess Alexandra Hospital (exploration cohort). Logistic regression models in conjunction with receiver-operator 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 to disentangle centre effects. Results: We find that the extent of acute neutrophilia in human SCI patients is positively correlated with New Injury Severity Scores (NISS) 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.

Schiff‐Sherrington syndromein a 7‐year‐old zebra mare (Equus quagga)

“…This could also be shown for human patients with acute spinal cord injury, where the circulating neutrophil count was highly associated with injury severity, lesion level and the neurological outcome of patients (Jogia et al, 2020). These findings might explain the marked leukocytosis the mare exhibited after acute spinal trauma.…”

“…Additionally, the extent to which neutrophils are mobilised and recruited to the lesion site is directly and inversely correlated with the severity of the lesion and outcomes in mice (Brennan et al., 2019). This could also be shown for human patients with acute spinal cord injury, where the circulating neutrophil count was highly associated with injury severity, lesion level and the neurological outcome of patients (Jogia et al., 2020). These findings might explain the marked leukocytosis the mare exhibited after acute spinal trauma.…”

Bioinformatics analysis of the wheel treadmill test on motor function recovery after spinal cord injury

“…Also, immune response and inflammatory response are the key pathological processes after SCI 28 . Jogia retrospectively analyzed 161 patients with SCI and found that early control of SCI‐induced systemic immune response was beneficial to longer‐term recovery 39 . Therefore, combined with the results, the promoting effect of the WTM test on the recovery of motor function in rats with SCI is most likely to be achieved by reducing the expression of the above genes and thus reducing the inflammatory response of rats after SCI.…”