Neurological examination in the acute phase after spinal cord injury (SCI) is often impossible and severely confounded by pharmacological sedation or concomitant injuries. Therefore, diagnostic biomarkers that objectively characterize severity or the presence of SCI are urgently needed to facilitate clinical decision-making. This study aimed to determine if serum markers of neural origin are related to: 1) presence and severity of SCI, and 2) magnetic resonance imaging (MRI) parameters in the very acute post-injury phase. We performed a secondary analysis of serological parameters, as well as MRI findings in patients with acute SCI (n = 38). Blood samples were collected between Days 1-4 post-injury. Serum protein levels of glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), and neurofilament light protein (NfL) were determined. A group of 41 age- and sex-matched healthy individuals served as control group. In the group of individuals with SCI, pre-operative sagittal and axial T2-weighted and sagittal T1-weighted MRI scans were available for 21 patients. Serum markers of neural origin are different among individuals who sustained traumatic SCI depending on injury severity, and the extent of the lesion according to MRI in the acute injury phase. Unbiased Recursive Partitioning regression with Conditional Inference Trees (URP-CTREE) produced preliminary cut-off values for NfL (75.217 pg/mL) and GFAP (73.121 pg/mL), allowing a differentiation between individuals with SCI and healthy controls within the first 4 days after SCI. Serum proteins NfL and GFAP qualify as diagnostic biomarkers for the presence and severity of SCI in the acute post-injury phase, where the reliability of clinical exams is limited.

中文翻译：

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血清胶质纤维酸性蛋白和神经丝轻蛋白水平与创伤性脊髓损伤后的神经功能障碍和脊髓水肿有关

脊髓损伤 (SCI) 后急性期的神经系统检查通常是不可能的，并且会因药物镇静或伴随损伤而严重混淆。因此，迫切需要客观地表征严重程度或 SCI 存在的诊断生物标志物来促进临床决策。本研究旨在确定神经源性血清标志物是否与以下因素有关：1) SCI 的存在和严重程度，以及 2) 非常急性损伤后阶段的磁共振成像 (MRI) 参数。我们对急性 SCI 患者的血清学参数和 MRI 结果进行了二次分析（n = 38)。在受伤后第 1-4 天之间收集血样。测定了胶质纤维酸性蛋白 (GFAP)、神经元特异性烯醇化酶 (NSE) 和神经丝轻蛋白 (NfL) 的血清蛋白水平。一组 41 名年龄和性别匹配的健康个体作为对照组。在 SCI 患者组中，21 名患者可进行术前矢状和轴向 T2 加权和矢状 T1 加权 MRI 扫描。神经起源的血清标志物在遭受创伤性 SCI 的个体之间是不同的，这取决于损伤的严重程度，以及根据 MRI 在急性损伤阶段的损伤程度。使用条件推理树 (URP-CTREE) 的无偏递归分区回归产生了 NfL (75.217 pg/mL) 和 GFAP (73.121 pg/mL) 的初步截止值，允许在 SCI 后的前 4 天内区分 SCI 患者和健康对照者。血清蛋白 NfL 和 GFAP 有资格作为急性损伤后阶段 SCI 存在和严重程度的诊断生物标志物，此时临床检查的可靠性是有限的。