Circulating Ubiquitin Carboxyl Terminal Hydrolase L1 and Neuroglobin Levels in Traumatic Spinal Cord Injuries: Relation to Severity and Outcomes

Figures & data

Figure 1 Male patient aged 36 years old with history of road traffic accident, lower limb paraparesis [L1 (lumbar vertebra 1) compressed fracture] more at the right side, AIS grade D, operated on for decompression and fixation, improved after 2 wks to AIS grade E. ((A) sagittal CT scan, (B) sagittal MRI, (C) axial MRI).

Figure 2 Male patient aged 43 years old with history of road traffic accident, patient was quadriplegic at time of examination, AIS grade A, MRI showed C4–5 (cervical vertebrae 4–5) fracture dislocation with corresponding cord contusion seen in the form of hyperintense signal in T2, and patient was operated on for reduction, fixation, and fusion. Patient was followed-up for 6 months with no improvement in his neurological state ((A and B) MRI axial view, (C) MRI sagittal view).

Table 1 Clinical Data of the Included Cases

Variables	Number (Total=33)	%
Level of the spinal cord injury
● Cervical	9	27.27
● Thoracic	9	27.27
● Lumbar	15	45.45
AIS
● A	13	39.39
● B	2	6.06
● C	8	24.24
● D	10	30.30
Type of spinal cord injury
● Partial	20	60.60
● Complete	13	39.39
Neurological affection
● Quadriplegia	6	18.18
● Quadreparesis	3	9.09
● Paraplegia	8	24.24
● Paraparesis	16	48.48
Etiology
● Motor car accident	12	36.36
● Falling from height	18	54.45
● Falling from stairs	3	9.09
Outcome
● Improved	19	57.57
● Not improved	14	42.42

Table 2 Serum UCHL1 and NGB Among the Study Groups

Biochemical Biomarkers	Cases (n=33)	Controls (n=30)	P value
UCHL1 (median, IQR; pg/mL)	1723(481–4185)	657(356–1175)	0.002*
NGB (median, IQR; pg/mL)	15.2(2.23–27.86)	7.52(5.05–25.3)	0.452

Note: *Significant p value ˂0.05.

Abbreviations: UCHL1, Ubiquitin carboxyl terminal hydrolase L1; NGB, neuroglobin; IQR, Interquartile range.

Figure 3 Comparison of the serum levels of UCHL1 (pg/mL) among patients with traumatic spinal cord injury and controls. *Significant (p value ˂0.05).

Table 3 Serum UCHL1 and NGB Among the Included Patients with TSCI According to AIS

Biochemical Biomarkers	A	(B+C+D+E)	P value
	(n= 13)	(n= 20)
UCHL1 (median, IQR; pg/mL)	3161.5(1723–4900)	833(481–4170)	0.043*
NGB (median, IQR; pg/mL)	8.01(0.82–23.8)	15.2(2.39–27.86)	0.279

Note: *Significant p value ˂0.05.

Abbreviations: UCHL1, Ubiquitin carboxyl terminal hydrolase L1; NGB, neuroglobin; IQR, interquartile range; TSCI, traumatic spinal cord injury; AIS, American spinal injury association (ASIA) impairment score (from A to E).

Figure 4 Comparison of the serum levels of UCHL1 (pg/mL) among patients with traumatic spinal cord injury with AIS grade A and those with others AIS grades (B–E). *Significant (p value ˂0.05).

Table 4 Serum UCHL1 and NGB Among the Included Patients with TSCI According to the Level of the Spinal Cord Injury

Biochemical Biomarkers	Cervical SCI	Thoracic SCI	Lumbar SCI	P value	P1	P2	P3
	(N= 9)	(N= 9)	(N= 15)
UCHL1 (median, IQR; pg/mL)	4700(1723–4975)	4200(4000–4500)	575(462–2707)	<0.001**	0.401	0.001**	0.012*
NGB (median, IQR; pg/mL)	15.2(0.82–26.66)	2.94(2.54–3)	26.66(2.23–30.66)	0.270	0.395	0.218	0.236

Notes: *Significant p value ˂0.05. **Significant p value ˂0.001. P1= cervical vs thoracic. P2= cervical vs lumbar. P3= thoracic vs lumbar.

Abbreviations: UCHL1, Ubiquitin carboxyl terminal hydrolase L1; NGB, neuroglobin; IQR, interquartile range; TSCI, traumatic spinal cord injury; AIS, American spinal injury association (ASIA) impairment score.

Figure 5 Serum levels of UCHL1 (pg/mL) among patients with traumatic spinal cord injury according to the level of injury. *Significant (p value ˂0.05).

Table 5 Serum UCHL1 and NGB Among the Included Patients with TSCI According to the Outcome

Biochemical Markers	Improved	Not Improved	P value
	(n= 19)	(n= 14)
UCHL1 (median, IQR; pg/mL)	1723 (1086.5–4800)	4700 (450–4950)	0.041*
NGB (median, IQR; pg/mL)	15.2 (2.23–26.66)	12.23 (0.82–20.93)	0.452

Note: *Significant p value ˂0.05.

Abbreviations: UCHL1, Ubiquitin carboxyl terminal hydrolase L1; NGB, neuroglobin; IQR, interquartile range; TSCI, traumatic spinal cord injury.

Figure 6 Serum levels of UCHL1 (pg/mL) among patients with traumatic spinal cord injury in terms of the outcome. *Significant (p value ˂0.05).

Table 6 Serum UCHL1 and NGB Levels Among the Study Groups in Terms of Gender

Biochemical Markers	Cases (n=33)		P value	Controls (n=30)		P value
	Males (n=24)	Females (n=9)		Males (n=21)	Females (n=9)
UCHL1 (median, IQR; pg/mL)	2861.5 (569–4575)	575 (462–2707)	0.072	657 (393.5–1175)	544 (356–1050)	0.449
NGB (median, IQR; pg/mL)	9.1 (1.17–26.66)	27.86 (9.17–30.66)	0.029*	7.52 (5.05–25.3)	18.8 (5.11–25.3)	0.782

Note: *Significant p value ˂0.05.

Abbreviations: UCHL1, Ubiquitin carboxyl terminal hydrolase L1; NGB, neuroglobin; IQR, interquartile range.

Figure 7 Receiver operative characteristic (ROC) curves for serum UCHL1 (pg/mL) in predicting severity (A) and outcome (B) of traumatic spinal cord injury.