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. 2019 Nov 1;36(21):3044-3050.
doi: 10.1089/neu.2018.6245. Epub 2019 Jun 17.

Association of Pneumonia, Wound Infection, and Sepsis with Clinical Outcomes after Acute Traumatic Spinal Cord Injury

Blessing N R Jaja  1   2 , Fan Jiang  1   3   4 , Jetan H Badhiwala  1   3 , Ralph Schär  2 , Shekar Kurpad  5 , Robert G Grossman  6 , James S Harrop  7 , Jim D Guest  8 , Elizabeth G Toups  6 , Chris I Shaffrey  9 , Bizhan Aarabi  10 , Max Boakye  11 , Michael G Fehlings  1   3 , Jefferson R Wilson  2   3
Affiliations

Association of Pneumonia, Wound Infection, and Sepsis with Clinical Outcomes after Acute Traumatic Spinal Cord Injury

Blessing N R Jaja et al. J Neurotrauma. .

Abstract

Pneumonia, wound infections, and sepsis (PWS) are the leading causes of acute mortality after traumatic spinal cord injury (SCI). However, the impact of PWS on neurological and functional outcomes is largely unknown. The present study analyzed participants from the prospective North American Clinical Trials Network (NACTN) registry and the Surgical Timing in Acute SCI Study (STASCIS) for the association between PWS and functional outcome (assessed as Spinal Cord Independence Measure subscores for respiration and indoor ambulation) at 6 months post-injury. Neurological outcome was analyzed as a secondary end-point. Among 1299 participants studied, 180 (14%) developed PWS during the acute admission. Compared with those without PWS, participants with PWS were mostly male (76% vs. 86%; p = 0.007), or presented with mostly American Spinal Injury Association Impairment Scale (AIS) grade A injury (36% vs. 61%; p < 0.001). There were no statistical differences between participants with or without PWS with respect to time from injury to surgery, and administration of steroids. Dominance analysis showed injury level, baseline AIS grade, and subject pre-morbid medical status collectively accounted for 77.7% of the predicted variance of PWS. Regression analysis indicated subjects with PWS demonstrated higher odds for respiratory (odds ratio [OR] 3.91, 95% confidence interval [CI]: 1.42-10.79) and ambulatory (OR 3.94, 95% CI: 1.50-10.38) support at 6 month follow-up in adjusted analysis. This study has shown an association between PWS occurring during acute admission and poorer functional outcomes following SCI.

Keywords: outcomes; pneumonia; sepsis; spinal cord injury; wound infection.

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Conflict of interest statement

CS discloses relationships with Medtronic (consulting, royalties, patents), Nuvasive (consulting, royalties, patents, stock ownership), Zimmer-Biomet (consulting, royalties, patents), and EOS (consulting). JH discloses relationships with Depuy (consulting), Stryker (honorarium), and Globus (honorarium). RGG discloses relationships with Vertex Pharmaceuticals (Data Safety Monitoring Board) and Insightec (Data Safety Monitoring Board). JRW discloses relationships with Stryker Canada (consulting and teaching). BNRJ, FJ, JHB, BA, RS, ET, SK, JDG, MB, and MGF have no potential conflicts to disclose.

Figures

<b>FIG. 1.</b>
FIG. 1.
Flowchart of patients in the analysis. NACTN, North American Clinical Trials Network; STASCIS, Surgical Timing in Acute SCI Study.
<b>FIG. 2.</b>
FIG. 2.
Forest plot showing a trend toward poorer neurological recovery at 6 months among the group with pneumonia, wound infection, and sepsis. AIS, American Spinal Injury Association Impairment Scale; CI, confidence interval; NACTN, North American Clinical Trials Network; OR, odds ratio; SCI, spinal cord injury; STASCIS, Surgical Timing in Acute SCI Study.
See this image and copyright information in PMC

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