Novel approach to an early assessment of a patient’s potential for neurological remission after acute spinal cord injury: Analysis of hemoglobin concentration dynamics

Abstract

Context/objective: Examining hemoglobin (Hb) dynamics with regard to the potential of neurological remission in patients with traumatic spinal cord injury (TSCI).

Design: Prospective Clinical Observational Study.

Setting: BG Trauma Centre Ludwigshafen, Department of Paraplegiology, Rhineland-Palatinate, Germany.

Methods: From 2011 to 2017 a total of 80 patients with acute spinal injury were enrolled and divided into three groups: initial neurological impairment either with (G1; n = 33) or without subsequent neurological remission (G0; n = 35) and vertebral fractures without initial neurological impairment as control group (C; n = 12). Blood samples were taken for 3 months at 11 time-points after injury. Analyses were performed using routine diagnostics.

Outcome measures: Multiple logistic regression was used to determine the prognostic value of Hb regarding neurological remission respecting clinical covariates.

Results: Data showed elevated mean Hb concentrations in G1 from the third day to 1 month compared to G0, Hb levels were significantly higher in G1 after 3 days (P = 0.03, G1 > G0). The final multiple logistic regression model based on this data predicting the presence of neurological remission resulted in an AUC (area under the curve) of 80.5% (CI: 67.8%–93.2%) in the ROC (receiver operating characteristic) analysis.

Conclusion: Elevated Hb concentrations are associated with a higher likelihood of neurological remission. Elevated concentrations of Hb in G1 compared to G0 over time might be linked to both a better initial oxygen supply response and a decreased ECM (extracellular matrix) degradation highlighting the role of Hb as a valuable biomarker for neural regeneration after TSCI.

Keywords:

• Neurological remission
• Traumatic spinal cord injury
• Hemoglobin
• Biomarker

Acknowledgments

We would like to thank the team of the Institute of Medical Biometry and Informatics, University of Heidelberg, Germany, for their excellent statistical consultation and Teresa Wiesinger (MAKD Heidelberg) for language editing and constructive criticism of the manuscript. We would also like to acknowledge the patients and controls for participating in this study.

Disclaimer statements

Contributors None.

Funding None.

Conflicts of interest None.

Ethics approval The study has been approved by the ethics committee of the University of Heidelberg (S-514/2011) and the Landesärztekammer Rheinland-Pfalz (837.188.12 / 8289-F), Germany.