TY - JOUR
T1 - Inflammatory Mediators Associated With Pressure Ulcer Development in Individuals With Pneumonia After Traumatic Spinal Cord Injury
T2 - A Pilot Study
AU - Krishnan, Shilpa
AU - Vodovotz, Yoram
AU - Karg, Patricia E.
AU - Constantine, Gregory
AU - Sowa, Gwendolyn A.
AU - Constantine, Florica J.
AU - Brienza, David M.
N1 - Publisher Copyright:
© 2017 American Congress of Rehabilitation Medicine
PY - 2017/9
Y1 - 2017/9
N2 - Objective To identify the inflammatory mediators around the time of pneumonia onset associated with concurrent or later onset of pressure ulcers (PUs). Design Retrospective. Setting Acute hospitalization and inpatient rehabilitation unit of a university medical center. Participants Individuals (N=86) with traumatic spinal cord injury (SCI) were included in the initial analyses. Fifteen of the 86 developed pneumonia and had inflammatory mediator data available. Of these 15, 7 developed PUs and 8 did not. Interventions Not applicable. Main Outcome Measures Twenty-three inflammatory mediators in plasma and urine were assayed. The differences in concentrations of plasma and urine inflammatory mediators between the closest time point before and after the diagnosis of pneumonia were calculated. Results Initial chi-square analysis revealed a significant (P=.02) association between pneumonia and PUs. Individuals with SCI and diagnosed pneumonia had nearly double the risk for developing PUs compared with those with no pneumonia. In individuals with pneumonia, Mann-Whitney U exact tests suggested an association (P<.05) between the formation of a first PU and a slight increase in plasma concentrations of tumor necrosis factor-alpha (TNF-α), and a decrease in urine concentrations of TNF-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin (IL)-15 after onset of pneumonia. Conclusions These findings suggest that a relatively small increase in plasma TNF-α, and decreases in urine TNF-α, GM-CSF, and IL-15 from just before to just after the diagnosis of pneumonia could be markers for an increased risk of PUs in individuals with pneumonia after traumatic SCI.
AB - Objective To identify the inflammatory mediators around the time of pneumonia onset associated with concurrent or later onset of pressure ulcers (PUs). Design Retrospective. Setting Acute hospitalization and inpatient rehabilitation unit of a university medical center. Participants Individuals (N=86) with traumatic spinal cord injury (SCI) were included in the initial analyses. Fifteen of the 86 developed pneumonia and had inflammatory mediator data available. Of these 15, 7 developed PUs and 8 did not. Interventions Not applicable. Main Outcome Measures Twenty-three inflammatory mediators in plasma and urine were assayed. The differences in concentrations of plasma and urine inflammatory mediators between the closest time point before and after the diagnosis of pneumonia were calculated. Results Initial chi-square analysis revealed a significant (P=.02) association between pneumonia and PUs. Individuals with SCI and diagnosed pneumonia had nearly double the risk for developing PUs compared with those with no pneumonia. In individuals with pneumonia, Mann-Whitney U exact tests suggested an association (P<.05) between the formation of a first PU and a slight increase in plasma concentrations of tumor necrosis factor-alpha (TNF-α), and a decrease in urine concentrations of TNF-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin (IL)-15 after onset of pneumonia. Conclusions These findings suggest that a relatively small increase in plasma TNF-α, and decreases in urine TNF-α, GM-CSF, and IL-15 from just before to just after the diagnosis of pneumonia could be markers for an increased risk of PUs in individuals with pneumonia after traumatic SCI.
KW - Biomarkers
KW - Rehabilitation
KW - Risk assessment
KW - Risk factors
KW - Ulcer
KW - Wounds and injuries
UR - http://www.scopus.com/inward/record.url?scp=85015983474&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2016.12.018
DO - 10.1016/j.apmr.2016.12.018
M3 - Article
C2 - 28130082
AN - SCOPUS:85015983474
SN - 0003-9993
VL - 98
SP - 1792
EP - 1799
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 9
ER -