Abstract
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.
Keywords
List of abbreviations:
GM-CSF (granulocyte-macrophage colony-stimulating factor), IL (interleukin), IL-1RA (IL-1 receptor antagonist), MIP (macrophage inflammatory protein), PU (pressure ulcer), SCI (spinal cord injury), t1 (within 1 week before pneumonia onset), t2 (within 1 week after pneumonia onset), TNF (tumor necrosis factor)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 24, 2017
Footnotes
Current affiliation for Krishnan, Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX.
Supported by the National Institute on Disability and Rehabilitation Research (NIDRR) (grant no. H133E070024 ), the Agency for Healthcare Research and Quality (AHRQ) (grant no. R24HS022134 ), and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant nos. 90SI5008 , 90AR5009 ). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
Disclosures: S.K. reports grants from NIDILRR and AHRQ during the conduct of the study. Y.V. reports grants from NIDRR during the conduct of the study, and is a cofounder and stakeholder in Immunetrics, Inc. P.E.K. reports grants from NIDRR during the conduct of the study. G.A.S. reports grants from the National Institutes of Health, UpToDate, the Patient-Centered Outcomes Research Institute, the Foundation for Physical Medicine and Rehabilitation, and the Wings of Life Foundation outside the submitted work. D.M.B. reports grants from the U.S. Department of Health and Human Services during the conduct of the study. The other authors have nothing to disclose.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
