Toward An Understanding Of Pressure Injury Risk And Local And Circulatory Biomarkers
Kath M. Bogie1, M Kristi Henzel2, Mary Ann Richmond2, Nannette Alvarado2, Jen Zindle2, Katie A. Schwartz2, David Lemmer2, Jacinta M. Seton2, Youjun Li1, Jiayang Sun1.
1Case Western Reserve University, Cleveland, OH, USA, 2Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
Background: Despite the best standards of care, pressure injures (PrI) prevention remains challenging for many people with spinal cord injury (SCI). The purpose of this study was to identify the more susceptible individuals within this high-risk population. Methods: A repeated measures study of 38 persons with SCI was carried out. Seated interface pressures and muscle composition were assessed at baseline and repeated annually. Local and circulatory biomarkers of muscle composition and inflammatory status were assessed in gluteal muscle biopsy and whole blood samples. Primary fatty metabolite biomarkers of interest were FABP4(adipose) and FABP3 (skeletal muscle). Results: Mean ischial region pressure did not vary between people with or without a PrI history. Higher levels of gluteal intramuscular fat (IMAT) were significantly related to having a history of severe/recurrent PrI (p<0.001). Circulatory FABP3 and FAPB4 were observed in persons with greater than 20% IMAT. Inflammatory biomarker expression was several fold lower than either FABP3 or FABP4. Macrophage migration inhibitory factor (MMIF), colony stimulating factors 1 and 3 (CSF-1, CSF-3) and VEGF-a were significantly related to having a history of severe/recurrent PrI. Conclusion: Pressure mapping alone is not a useful measure of PrI risk. Muscle microstructure impacts the overall biomechanical response of the muscle to applied load and the uniformity of intramuscular load distribution. Loaded muscle with high IMAT infiltration acts like a mixed composite material. Changes in muscle composition, specifically increased IMAT, provide clinically significant risk factors for PrI. Circulatory biomarkers also vary with muscle composition. Levels of inflammatory biomarker expression may too low to be of routine clinical significance, e.g. indicative of infection, but may provide an indicator of underlying sub-clinical differences in inflammatory status and PrI risk.
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