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Inflammatory Mediators Associated With Pressure Ulcer Development in Individuals With Pneumonia After Traumatic Spinal Cord Injury: A Pilot Study

Published:January 24, 2017DOI:https://doi.org/10.1016/j.apmr.2016.12.018

      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)
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