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Factors Associated With Occurrence and Early Detection of Pressure Ulcers Following Traumatic Spinal Cord Injury

Krishnan, Shilpa (2014) Factors Associated With Occurrence and Early Detection of Pressure Ulcers Following Traumatic Spinal Cord Injury. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Pressure ulcers (PUs) are serious secondary complications occurring in individuals with spinal cord injury (SCI). PUs not only decrease quality of life, but can adversely affect physical, psychological, emotional and financial status. Although studies have investigated general risk factors for PUs, few have focused on the time period immediately following SCI when the inflammation associated with SCI may influence the body’s ability to tolerate secondary tissue damage leading to occurrence of PUs. Biomarkers obtained from plasma and urine biofluids are commonly used to characterize inflammation.
The Rehabilitation Engineering Research Center on SCI (RERC on SCI) recruited individuals with new traumatic SCI (TSCI). Data were collected at predetermined time points in acute care, inpatient rehabilitation and after discharge on the risk factors and incidence of PUs, and on plasma and urine inflammatory mediators. A secondary analysis was performed on data obtained from the 104 individuals with TSCI.
The purpose of this study was to investigate the association of clinical, demographic and inflammatory factors with the formation of PUs following TSCI during acute care hospitalization and inpatient rehabilitation. Severity of SCI (ASIA A) and presence of pneumonia were determined to predict PU incidence. Plasma concentrations of IL-1RA, GM-CSF, MIP-1α, IFN- γ, IL-5, IL-17, MIG and MIP-1β; and urine concentrations of IL-6, IL-8, IL-13, IP-10, MCP-1, IFN-γ, IL-5, IL-17, MIG and TNF-α were associated with formation of PU, immediately after SCI. An increase in the plasma concentrations of IP-10 and a decrease in the urine concentrations of IFN-α were observed just before formation of the first PU. A significant association between presence of pneumonia and formation of PU was observed as compared to no pneumonia. This association between PU and pneumonia could be linked through inflammation. Increased plasma synthesis of IFN-α and urine synthesis of IL-1RA were associated with formation of PU in individuals with pneumonia.
The findings of this study suggest that an imbalance in the inflammatory response after SCI may be associated with formation of PUs. The findings also suggest an association between the presence of pneumonia and formation of PU, which could be linked through inflammation.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Krishnan, Shilpashk59@pitt.eduSHK59
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBrienza, Daviddbrienza@pitt.eduDBRIENZA
Committee MemberBoninger, Michael Lboninger@upmc.eduBONINGER
Committee MemberConstantine, Gregorygmc@pitt.eduGMC
Committee MemberKarg, Patricia tkarg@pitt.eduTKARG
Committee MemberVodovotz, Yoramvodovotz@pitt.eduVODOVOTZ
Date: 23 May 2014
Date Type: Publication
Defense Date: 31 January 2014
Approval Date: 23 May 2014
Submission Date: 15 April 2014
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 255
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Spinal Cord Injury, Pressure Ulcers, Inflammation, acute care, inpatient, risk factors, early detection, cytokines,pneumonia,chemokines
Date Deposited: 23 May 2014 15:01
Last Modified: 19 Dec 2016 14:41


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