Inflammatory mediators associated with pressure ulcer development in individuals with pneumonia following traumatic spinal cord injury: A pilot study

Publication date: Available online 25 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Shilpa Krishnan, Yoram Vodovotz, Patricia E. Karg, Gregory Constantine, Gwendolyn A. Sowa, Florica J. Constantine, David M. Brienza
ObjectiveTo identify the inflammatory mediators around the time of pneumonia onset associated with concurrent or later onset of pressure ulcers.DesignRetrospectiveSettingAcute hospitalization and inpatient rehabilitation unit of a university medical center.InterventionsNA.ParticipantsEighty-six individuals with traumatic SCI were included in the initial analyses. Fifteen of the 86 developed pneumonia and had inflammatory mediator data available. Of these 15, seven developed pressure ulcers and eight did not develop pressure ulcers.Outcome MeasuresTwenty-three inflammatory mediators in plasma and urine were assayed using Luminex. The differences in concentrations of plasma and urine inflammatory mediators between the closest time point before and after the diagnosis of pneumonia were calculated.ResultsInitial Chi-Square analysis revealed a significant (p=0.02) association between pneumonia and pressure ulcers. Individuals with SCI diagnosed with pneumonia had nearly double the risk for developing pressure ulcers compared to those with no pneumonia. In individuals with pneumonia, Mann Whitney U exact tests suggested an association (p<0.05) between the formation of a first pressure ulcer and a slight increase in plasma concentrations of tumor necrosis factor-alpha (TNF-α), and decrease in urine concentrations of TNF-α, and granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin (IL)-15 following onset of pneumonia.ConclusionThese 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 pressure ulcers in individuals with pneumonia post traumatic SCI.



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