|Paper title||Serum biomarkers as predictors of severity of injury and functional outcome after acute traumatic spinal cord injury|
|Form of presentation||Poster|
Aims – To evaluate the potential importance of biochemical markers as predictors of severity of injury and functional outcome after acute traumatic spinal cord injury (SCI).
Methods – In a prospective cohort study of adult (age range, 18-65 years) acute traumatic SCI patients with spinal column fracture (presenting within 24 hours of injury), a total of 26 patients were recruited within one year of study. Quantitative assessment of serum biomarkers (S-100 B protein [S-100], Neuron specific Enolase [NSE], Glial Fibrillary Acidic Protein [GFAP] and phosphorylated form of heavy subunit of neurofilament [pNF-H]) was performed using sandwich enzyme-linked immunosorbent assay technique at admission, at 2 days and 7 days after injury. The predictive potential of serum biomarkers for severity of SCI and 6-month functional outcome, dichotomised based on American Spinal Injury Association impairment scale (ASIA), was analyzed using Mann-Whitney U test and receiver-operating characteristic curve analysis.
Results – This study cohort included predominantly male population (84.6%) and cervical spine injury (69.2%) as the most common presentation. A total of 34.6% patients were alive and followed till 6 months, while 38.5% patients expired and the remaining 26.9% were lost to follow-up. Day-2 GFAP serum levels > 0.34 ng/ml predicted the non-functional status of the patient and complete SCI (AUC 0.77, CI = 0.56-0.98, sensitivity 73.3%, specificity 80%, p = 0.07 and AUC 0.76, CI = 0.55-0.97, sensitivity 76.9%, specificity 71.4%, p = 0.09 respectively). Day-7 GFAP serum levels > 0.32 ng/ml predicted the complete SCI at admission (AUC 0.78, CI = 0.53-1.00, sensitivity 76.9%, specificity 80%, p = 0.07). Day-7 S100 serum levels > 100 pg/ml predicted the non-functional status of the patient and complete SCI at 6-months (AUC 0.86, CI = 0.58-1.00, sensitivity 66.7%, specificity 100%, p = 0.09 and AUC 1.00, CI = 1.00-1.00, sensitivity 100%, specificity 100%, p = 0.04 respectively).
Conclusions – Serial monitoring and optimization of serum GFAP and S100-B levels could aid in assessment of severity of injury and prognostication of acute traumatic SCI patients and guide us to direct resources toward such patients for optimal outcome. Whether it’s a cause-effect relation or just a mere association of these biomarkers to severity of clinical presentation and outcome needs to be further validated.