title: Inflammatory Mediators Associated With Pressure Ulcer Development in Individuals With Pneumonia After Traumatic Spinal Cord Injury: A Pilot Study.
abstract: To identify the inflammatory mediators around the time of pneumonia onset associated with concurrent or later onset of pressure ulcers (PUs).
  
  
  
  Retrospective.
  
  
  
  Acute hospitalization and inpatient rehabilitation unit of a university medical center.
  
  
  
  Individuals (N=86) with traumatic spinal cord injury (SCI) were included in the initial analyses. Fifteen of the 86 developed pneumonia and had inflammatory mediator data available. Of these 15, 7 developed PUs and 8 did not.
  
  
  
  Not applicable.
  
  
  
  Twenty-three inflammatory mediators in plasma and urine were assayed. The differences in concentrations of plasma and urine inflammatory mediators between the closest time point before and after the diagnosis of pneumonia were calculated.
  
  
  
  Initial chi-square analysis revealed a significant (P=.02) association between pneumonia and PUs. Individuals with SCI and diagnosed pneumonia had nearly double the risk for developing PUs compared with those with no pneumonia. In individuals with pneumonia, Mann-Whitney U exact tests suggested an association (P<.05) between the formation of a first PU and a slight increase in plasma concentrations of tumor necrosis factor-alpha (TNF-α), and a decrease in urine concentrations of TNF-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin (IL)-15 after onset of pneumonia.
  
  
  
  These 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 PUs in individuals with pneumonia after traumatic SCI.
authors.affiliation: Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA. Electronic address: shikrish@utmb.edu.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Krishnan
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Vodovotz
authors.affiliation: Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Karg
authors.affiliation: Department of Mathematics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Constantine
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Gwendolyn A
authors.initials: GA
authors.lastname: Sowa
authors.affiliation: Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD.
authors.forename: Florica J
authors.initials: FJ
authors.lastname: Constantine
authors.affiliation: Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA.
authors.forename: David M
authors.initials: DM
authors.lastname: Brienza
mesh_terms: D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000652:urine; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood* / Q000652:urine*; D019409:Interleukin-15 / Q000652:urine; D008297:Male; D010865:Pilot Projects; D011014:Pneumonia / Q000097:blood / Q000150:complications* / Q000652:urine; D003668:Pressure Ulcer / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000097:blood / Q000150:complications* / Q000652:urine; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000652:urine
chemical_list: C569274:IL15 protein, human; D018836:Inflammation Mediators; D019409:Interleukin-15; D014409:Tumor Necrosis Factor-alpha; D016178:Granulocyte-Macrophage Colony-Stimulating Factor
keywords: Biomarkers; Rehabilitation; Risk assessment; Risk factors; Ulcer; Wounds and injuries