Serum Neuritin is a Predictive Biomarker of Poor Neurological Recovery After Traumatic Spinal Cord Injury: A Prospective Cohort Study.

OBJECTIVE

Traumatic spinal cord injury (TSCI) is a severe neurological urgency. Neuritin is a neurotrophic factor. This study aimed to explore prognostic predictive value of serum neuritin levels in TSCI.

METHODS

In this prospective cohort study, serum neuritin levels were quantified at admission of 126 patients and at study entry of 126 controls. The American Spinal Injury Association Impairment Scale (AIS) was used as the severity index. Poor prognosis was defined as no improvement in AIS grade at six months post TSCI versus admission. The results were analyzed using multivariate regression method.

RESULTS

Serum neuritin levels were significantly higher in patients with TSCI than in controls. No significant departure from linearity was detected between serum neuritin levels, AIS grade and poor prognosis in the restricted cubic spline. AIS grade was independently correlated with serum neuritin levels. Age, AIS grade, and serum neuritin levels were independently associated with poor prognosis. Receiver operating characteristic (ROC) curve analysis showed that poor prognosis was effectively predicted by serum neuritin levels. The results of the regression analysis were robust via sensitivity analysis, variance inflation factor estimation, the Hosmer-Lemeshow test, and Brier score calculation. The prognosis model incorporating AIS grade, age, and serum neuritin levels was visualized by nomogram, had satisfactory goodness of fit under the calibration curve, showed substantially high discrimination efficiency through the ROC curve approach, and displayed good clinical validity as demonstrated by the decision curve through internal validation. Serum neuritin levels partially mediated the association between AIS grade and poor prognosis.

CONCLUSIONS

Elevated serum neuritin levels are closely associated with TSCI severity and poor prognosis following TSCI, indicating that serum neuritin may serve as a potential prognostic biomarker of TSCI.