The spinal cord injury-induced immune deficiency syndrome: results of the SCIentinel study

Brain, 2023 · DOI: https://doi.org/10.1093/brain/awad092 · Published: June 28, 2023

Simple Explanation

Spinal cord injury (SCI) can lead to a weakened immune system, making patients more susceptible to infections. This study, called SCIentinel, investigated how SCI affects the immune system by comparing SCI patients with different injury levels and severities to patients with vertebral fractures but no SCI. The study found that SCI patients, especially those with high and complete injuries, had lower levels of a key immune marker (mHLA-DR), indicating a suppressed immune state. These patients also had lower levels of certain antibodies (immunoglobulins). These immune deficiencies were associated with a higher risk of infections. The study suggests that SCI can cause a specific type of immune deficiency syndrome, separate from the general immune effects of trauma.

Study Duration

From 2011 to 2014, with follow-up at 10 weeks

Participants

111 patients: SCI patients (high and low, complete and incomplete) and vertebral fracture (VF) patients without SCI

Evidence Level

Prospective multicentre cohort study

Key Findings

1
SCI patients, particularly those with high and complete injuries, exhibited significantly reduced mHLA-DR expression, indicating a suppressed immune state.
2
Complete, high SCI patients showed constantly lower serum immunoglobulin G and A levels up to 10 weeks after injury, suggesting impaired humoral immunity.
3
Low mHLA-DR levels were positively associated with the occurrence and earlier onset of infections in SCI patients, highlighting the clinical relevance of immune suppression.

Research Summary

The SCIentinel study prospectively assessed the impact of spinal cord injury (SCI) on the immune system, comparing SCI patients with varying injury levels and severities to vertebral fracture (VF) patients without SCI. The study revealed that SCI patients, especially those with high and complete injuries, developed a neurogenic immune deficiency syndrome (SCI-IDS) characterized by reduced mHLA-DR expression and hypogammaglobulinaemia. This SCI-IDS was associated with increased susceptibility to infections, with low mHLA-DR levels correlating with the occurrence and earlier onset of infections, suggesting a direct neurogenic contribution to immune suppression.

Practical Implications

Risk Stratification

mHLA-DR expression can be used to stratify infection risk in SCI patients.

Treatment Target

SCI-IDS qualifies as a treatment target to restore host defence and reduce infection susceptibility.

Triage Protocols

The findings can inform the development of triage protocols for particularly immune-suppressed patients.

Study Limitations

1
Inability to fully distinguish between direct immunological effects and indirect SCI-related motor effects on infection susceptibility.
2
The fact that these mHLA-DR levels then recovered only slowly and partially may also be due to the effects of early infections putatively reducing mHLA-DR expression further.
3
Variations in the severity of accompanying injuries may still constitute an unmeasured confounder contributing to the variance in lymphocyte data.

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