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Blex C, Kreutzträger M, Ludwig J, Nowak CP, Schwab JM, Lübstorf T, Ekkernkamp A, Kopp MA, Liebscher T. Baseline predictors of in-hospital mortality after acute traumatic spinal cord injury: data from a level I trauma center. Sci Rep 2022; 12:11420. [PMID: 35794189 PMCID: PMC9259676 DOI: 10.1038/s41598-022-15469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Comorbidity scores are important predictors of in-hospital mortality after traumatic spinal cord injury (tSCI), but the impact of specific pre-existing diseases is unknown. This retrospective cohort study aims at identifying relevant comorbidities and explores the influence of end-of-life decisions. In-hospital mortality of all patients admitted to the study center after acute tSCI from 2011 to 2017 was assessed. A conditional inference tree analysis including baseline data, injury characteristics, and Charlson Comorbidity Index items was used to identify crucial predictors. End-of-life decisions were recorded. Three-hundred-twenty-one patients were consecutively enrolled. The median length of stay was 95.7 days (IQR 56.8-156.0). During inpatient care, 20 patients (6.2%) died. These patients were older (median: 79.0 (IQR 74.7-83.2) vs. 55.5 (IQR 41.4-72.3) years) and had a higher Charlson Comorbidity Index score (median: 4.0 (IQR 1.75-5.50) vs. 0.0 (IQR 0.00-1.00)) compared to survivors. Pre-existing kidney or liver disease were identified as relevant predictors of in-hospital mortality. End-of-life decisions were observed in 14 (70.0%) cases. The identified impairment of kidney and liver, important for drug metabolism and elimination, points to the need of careful decisions on pharmaceutical treatment regimens after tSCI. Appropriate reporting of end-of-life decisions is required for upcoming studies.
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Affiliation(s)
- Christian Blex
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- QUEST-Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany.
| | - Martin Kreutzträger
- Treatment Center for Spinal Cord Injuries, Trauma Hospital Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Johanna Ludwig
- Treatment Center for Spinal Cord Injuries, Trauma Hospital Berlin, Warener Str. 7, 12683, Berlin, Germany
- Clinic for Trauma Surgery and Orthopedics, Trauma Hospital Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Claus Peter Nowak
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Jan M Schwab
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Spinal Cord Injury Medicine (Neuroparaplegiology), Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
- Belford Center for Spinal Cord Injury, Departments of Neuroscience and Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Tom Lübstorf
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Axel Ekkernkamp
- Clinic for Trauma Surgery and Orthopedics, Trauma Hospital Berlin, Warener Str. 7, 12683, Berlin, Germany
- Department of Traumatology, University of Greifswald, Sauerbruchstraße, 17491, Greifswald, Germany
| | - Marcel A Kopp
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- QUEST-Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany.
| | - Thomas Liebscher
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Treatment Center for Spinal Cord Injuries, Trauma Hospital Berlin, Warener Str. 7, 12683, Berlin, Germany
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Kopp MA, Lübstorf T, Blex C, Schwab JM, Grittner U, Auhuber T, Ekkernkamp A, Niedeggen A, Prillip E, Hoppe M, Ludwig J, Kreutzträger M, Liebscher T. Association of age with the timing of acute spine surgery-effects on neurological outcome after traumatic spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:56-69. [PMID: 34533643 DOI: 10.1007/s00586-021-06982-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 08/02/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the association of age with delay in spine surgery and the effects on neurological outcome after traumatic spinal cord injury (SCI). METHODS Ambispective cohort study (2011-2017) in n = 213 patients consecutively enrolled in a Level I trauma center with SCI care in a metropolitan region in Germany. Age-related differences in the injury to surgery interval and conditions associated with its delay (> 12 h after SCI) were explored using age categories or continuous variables and natural cubic splines. Effects of delayed surgery or age with outcome were analyzed using multiple logistic regression. RESULTS The median age of the study population was 58.8 years (42.0-74.6 IQR). Older age (≥ 75y) was associated with a prolonged injury to surgery interval of 22.8 h (7.2-121.3) compared to 6.6 h (4.4-47.9) in younger patients (≤ 44y). Main reasons for delayed surgery in older individuals were secondary referrals and multimorbidity. Shorter time span to surgery (≤ 12 h) was associated with higher rates of ASIA impairment scale (AIS) conversion (OR 4.22, 95%CI 1.85-9.65), as mirrored by adjusted spline curves (< 20 h 20-25%, 20-60 h 10-20%, > 60 h < 10% probability of AIS conversion). In incomplete SCI, the probability of AIS conversion was lower in older patients [e.g., OR 0.09 (0.02-0.44) for'45-59y' vs.' ≤ 44y'], as confirmed by spline curves (< 40y 20-80%, ≥ 40y 5-20% probability). CONCLUSION Older patient age complexifies surgical SCI care and research. Tackling secondary referral to Level I trauma centers and delayed spine surgery imposes as tangible opportunity to improve the outcome of older SCI patients.
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Affiliation(s)
- Marcel A Kopp
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Berlin Institute of Health, QUEST-Center for Transforming Biomedical Research, Berlin, Germany.
| | - Tom Lübstorf
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christian Blex
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan M Schwab
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Belford Center for Spinal Cord Injury, Departments of Neurology, Physical Medicine and Rehabilitation, and Neurosciences, The Neuroscience Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Thomas Auhuber
- Medical Management, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
- University of Applied Sciences of the German Statutory Accident Insurance (HGU), Bad Hersfeld, Germany
| | - Axel Ekkernkamp
- Clinic for Trauma Surgery and Orthopaedics, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Andreas Niedeggen
- Brandenburg Center for Spinal Cord Injuries, Kliniken Beelitz, Beelitz-Heilstätten, Germany
- Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Erik Prillip
- Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Magdalena Hoppe
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Johanna Ludwig
- Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Martin Kreutzträger
- Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Thomas Liebscher
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
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Three Growth Factors Induce Proliferation and Differentiation of Neural Precursor Cells In Vitro and Support Cell-Transplantation after Spinal Cord Injury In Vivo. Stem Cells Int 2020; 2020:5674921. [PMID: 32774390 PMCID: PMC7399764 DOI: 10.1155/2020/5674921] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022] Open
Abstract
Stem cell therapy with neural precursor cells (NPCs) has the potential to improve neuroregeneration after spinal cord injury (SCI). Unfortunately, survival and differentiation of transplanted NPCs in the injured spinal cord remains low. Growth factors have been successfully used to improve NPC transplantation in animal models, but their extensive application is associated with a relevant financial burden and might hinder translation of findings into the clinical practice. In our current study, we assessed the potential of a reduced number of growth factors in different combinations and concentrations to increase proliferation and differentiation of NPCs in vitro. After identifying a “cocktail” (EGF, bFGF, and PDGF-AA) that directed cell fate towards the oligodendroglial and neuronal lineage while reducing astrocytic differentiation, we translated our findings into an in vivo model of cervical clip contusion/compression SCI at the C6 level in immunosuppressed Wistar rats, combining NPC transplantation and intrathecal administration of the growth factors 10 days after injury. Eight weeks after SCI, we could observe surviving NPCs in the injured animals that had mostly differentiated into oligodendrocytes and oligodendrocytic precursors. Moreover, “Stride length” and “Average Speed” in the CatWalk gait analysis were significantly improved 8 weeks after SCI, representing beneficial effects on the functional recovery with NPC transplantation and the administration of the three growth factors. Nevertheless, no effects on the BBB scores could be observed over the course of the experiment and regeneration of descending tracts as well as posttraumatic myelination remained unchanged. However, reactive astrogliosis, as well as posttraumatic inflammation and apoptosis was significantly reduced after NPC transplantation and GF administration. Our data suggest that NPC transplantation is feasible with the use of only EGF, bFGF, and PDGF-AA as supporting growth factors.
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