Factors Associated With Occurrence and Early Detection of Pressure Ulcers Following Traumatic Spinal Cord Injury

摘要

Pressure ulcers (PUs) are serious secondary complications occurring in individuals with spinal cord injury (SCI). PUs not only decrease quality of life, but can adversely affect physical, psychological, emotional and financial status. Although studies have investigated general risk factors for PUs, few have focused on the time period immediately following SCI when the inflammation associated with SCI may influence the body’s ability to tolerate secondary tissue damage leading to occurrence of PUs. Biomarkers obtained from plasma and urine biofluids are commonly used to characterize inflammation.udThe Rehabilitation Engineering Research Center on SCI (RERC on SCI) recruited individuals with new traumatic SCI (TSCI). Data were collected at predetermined time points in acute care, inpatient rehabilitation and after discharge on the risk factors and incidence of PUs, and on plasma and urine inflammatory mediators. A secondary analysis was performed on data obtained from the 104 individuals with TSCI.udThe purpose of this study was to investigate the association of clinical, demographic and inflammatory factors with the formation of PUs following TSCI during acute care hospitalization and inpatient rehabilitation. Severity of SCI (ASIA A) and presence of pneumonia were determined to predict PU incidence. Plasma concentrations of IL-1RA, GM-CSF, MIP-1α, IFN- γ, IL-5, IL-17, MIG and MIP-1β; and urine concentrations of IL-6, IL-8, IL-13, IP-10, MCP-1, IFN-γ, IL-5, IL-17, MIG and TNF-α were associated with formation of PU, immediately after SCI. An increase in the plasma concentrations of IP-10 and a decrease in the urine concentrations of IFN-α were observed just before formation of the first PU. A significant association between presence of pneumonia and formation of PU was observed as compared to no pneumonia. This association between PU and pneumonia could be linked through inflammation. Increased plasma synthesis of IFN-α and urine synthesis of IL-1RA were associated with formation of PU in individuals with pneumonia. udThe findings of this study suggest that an imbalance in the inflammatory response after SCI may be associated with formation of PUs. The findings also suggest an association between the presence of pneumonia and formation of PU, which could be linked through inflammation. udud