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We explored risk factors for UTI, including immunological biomarkers, in patients with acute traumatic SCI during the transition from acute to subacute phase. Two observational studies were analysed separately: a retrospective study (COaT-SCI, n\u2009=\u2009296, follow-up 13\u00a0weeks), and a prospective immunological study (SCIentinel, n\u2009=\u200970, follow-up 10\u00a0weeks). Cox regression models were used to examine associations of first UTI with patient characteristics and longitudinal immunological parameters. Cumulative incidence of first UTI was approximately 50% at six weeks. Results indicated higher UTI risk in older patients and time-varying associations for SCI severity (ASIA impairment scale) and presence of accompanying injuries. Higher cellular immune competence, particularly CD8\u2009+\u2009T-cell counts and higher IFN-\u03b3\/IL-4 ratio in functional T-cell assays, were associated with a lower UTI risk (HR [95% CI] per log-transformed unit: CD8\u2009+\u2009T-cells 0.34 [0.18\u20140.65], IFN-\u03b3\/IL-4 ratio 0.53 [0.33\u20130.83]). Adding cellular immune markers improved models\u2019 discriminative ability (weighted C-index at 21\u00a0days from 0.68 to 0.76 with CD8\u2009+\u2009T-cells). These findings indicate UTI is facilitated by systemic immune alterations, with T-cell parameters representing promising predictive biomarkers requiring further validation before clinical implementation.<\/jats:p>","DOI":"10.1038\/s41598-025-34852-0","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T18:32:08Z","timestamp":1768069928000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["T-cell biomarkers improve urinary tract infection risk stratification beyond clinical characteristics after acute traumatic spinal cord injury"],"prefix":"10.1038","volume":"16","author":[{"given":"Oliver","family":"Schweizerhof","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Meisel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Blex","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Cinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Watzlawick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"L\u00fcbstorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura-Christin","family":"Geurtz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kreutztr\u00e4ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Baumgartner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Hirt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Hoppe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Unterwalder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"K\u00f6lsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"B\u00f6thig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"Domurath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Druschel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus-Dieter","family":"Schaser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Niedeggen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Curt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Ekkernkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Liebscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan M.","family":"Schwab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel A.","family":"Kopp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Grittner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,10]]},"reference":[{"key":"34852_CR1","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1038\/sc.2016.173","volume":"55","author":"L Garcia-Arguello","year":"2017","unstructured":"Garcia-Arguello, L. et al. 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