{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T06:12:08Z","timestamp":1793772728505,"version":"4.6.1"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"German Research Council","doi-asserted-by":"publisher","award":["81717034"],"award-info":[{"award-number":["81717034"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008191","name":"Wings for Life Spinal Cord Research Foundation","doi-asserted-by":"publisher","award":["WfL-DE-006\/12"],"award-info":[{"award-number":["WfL-DE-006\/12"]}],"id":[{"id":"10.13039\/100008191","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008191","name":"Wings for Life Spinal Cord Research Foundation","doi-asserted-by":"publisher","award":["WfL-DE-16\/16"],"award-info":[{"award-number":["WfL-DE-16\/16"]}],"id":[{"id":"10.13039\/100008191","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008191","name":"Wings for Life Spinal Cord Research Foundation","doi-asserted-by":"publisher","award":["WfL-DE-11\/20"],"award-info":[{"award-number":["WfL-DE-11\/20"]}],"id":[{"id":"10.13039\/100008191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Infections are prevalent after spinal cord injury (SCI), constitute the main cause of death and are a rehabilitation confounder associated with impaired recovery. We hypothesize that SCI causes an acquired lesion-dependent (neurogenic) immune suppression as an underlying mechanism to facilitate infections.<\/jats:p>\n                  <jats:p>The international prospective multicentre cohort study (SCIentinel; protocol registration DRKS00000122; n = 111 patients) was designed to distinguish neurogenic from general trauma-related effects on the immune system. Therefore, SCI patient groups differing by neurological level, i.e. high SCI [thoracic (Th)4 or higher]; low SCI (Th5 or lower) and severity (complete SCI; incomplete SCI), were compared with a reference group of vertebral fracture (VF) patients without SCI. The primary outcome was quantitative monocytic Human Leukocyte Antigen-DR expression (mHLA-DR, synonym MHC II), a validated marker for immune suppression in critically ill patients associated with infection susceptibility. mHLA-DR was assessed from Day 1 to 10 weeks after injury by applying standardized flow cytometry procedures. Secondary outcomes were leucocyte subpopulation counts, serum immunoglobulin levels and clinically defined infections. Linear mixed models with multiple imputation were applied to evaluate group differences of logarithmic-transformed parameters.<\/jats:p>\n                  <jats:p>Mean quantitative mHLA-DR [ln (antibodies\/cell)] levels at the primary end point 84 h after injury indicated an immune suppressive state below the normative values of 9.62 in all groups, which further differed in its dimension by neurological level: high SCI [8.95 (98.3% confidence interval, CI: 8.63; 9.26), n = 41], low SCI [9.05 (98.3% CI: 8.73; 9.36), n = 29], and VF without SCI [9.25 (98.3% CI: 8.97; 9.53), n = 41, P = 0.003]. Post hoc analysis accounting for SCI severity revealed the strongest mHLA-DR decrease [8.79 (95% CI: 8.50; 9.08)] in the complete, high SCI group, further demonstrating delayed mHLA-DR recovery [9.08 (95% CI: 8.82; 9.38)] and showing a difference from the VF controls of \u22120.43 (95% CI: \u22120.66; \u22120.20) at 14 days. Complete, high SCI patients also revealed constantly lower serum immunoglobulin G [\u22120.27 (95% CI: \u22120.45; \u22120.10)] and immunoglobulin A [\u22120.25 (95% CI: \u22120.49; \u22120.01)] levels [ln (g\/l \u00d7 1000)] up to 10 weeks after injury. Low mHLA-DR levels in the range of borderline immunoparalysis (below 9.21) were positively associated with the occurrence and earlier onset of infections, which is consistent with results from studies on stroke or major surgery.<\/jats:p>\n                  <jats:p>Spinal cord injured patients can acquire a secondary, neurogenic immune deficiency syndrome characterized by reduced mHLA-DR expression and relative hypogammaglobulinaemia (combined cellular and humoral immune deficiency). mHLA-DR expression provides a basis to stratify infection-risk in patients with SCI.<\/jats:p>","DOI":"10.1093\/brain\/awad092","type":"journal-article","created":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T19:59:05Z","timestamp":1679428745000},"page":"3500-3512","source":"Crossref","is-referenced-by-count":33,"title":["The spinal cord injury-induced immune deficiency syndrome: results of the SCIentinel study"],"prefix":"10.1093","volume":"146","author":[{"given":"Marcel A","family":"Kopp","sequence":"first","affiliation":[{"name":"Spinal Cord Injury Research (Neuroparaplegiology), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"},{"name":"Department of Neurology and Experimental Neurology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"},{"name":"Berlin Institute of Health, QUEST-Center for Transforming Biomedical Research , 10178 Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Meisel","sequence":"additional","affiliation":[{"name":"Institute of Medical Immunology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"},{"name":"Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin , Germany"},{"name":"Department of Immunology, Labor Berlin\u2014Charit\u00e9 Vivantes GmbH , 13353 Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Liebscher","sequence":"additional","affiliation":[{"name":"Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin , 12683 Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Watzlawick","sequence":"additional","affiliation":[{"name":"Spinal Cord Injury Research (Neuroparaplegiology), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"},{"name":"Department of Neurology and Experimental Neurology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"},{"name":"Department of Neurosurgery, Freiburg University Medical Center , 79106 Freiburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Cinelli","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Zurich, University of Zurich , 8091 Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Schweizerhof","sequence":"additional","affiliation":[{"name":"Institute of Biometry and Clinical Epidemiology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10115 Berlin , Germany"},{"name":"Berlin Institute of Health (BIH) , 10178 Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Blex","sequence":"additional","affiliation":[{"name":"Spinal Cord Injury Research (Neuroparaplegiology), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"},{"name":"Department of Neurology and Experimental Neurology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"L\u00fcbstorf","sequence":"additional","affiliation":[{"name":"Spinal Cord Injury Research (Neuroparaplegiology), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"},{"name":"Department of Neurology and Experimental Neurology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 10117 Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Prilipp","sequence":"additional","affiliation":[{"name":"Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin , 12683 Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Niedeggen","sequence":"additional","affiliation":[{"name":"Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin , 12683 Berlin , Germany"},{"name":"Brandenburg Center for Spinal Cord Injuries, Kliniken Beelitz , 14547 Beelitz-Heilst\u00e4tten , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Druschel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Universit\u00e4tsklinikum Carl-Gustav Carus 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