Respiratory Instructional Course:
Tracks
Thalie
| Tuesday, November 5, 2019 |
| 9:55 AM - 11:25 AM |
| Thalie |
Overview
Pulmonary Infections as Outcome Modifying Factors after Spinal Cord Injury
Speaker
Dr Marcel Kopp
Co-group leader
Charité-universitätsmedizin Berlin
Pulmonary Infections as Outcome Modifying Factors after Spinal Cord Injury – Mechanisms and Objective Markers of Neurogenic Immune Depression and Definition of Infections for Acute Management and Clinical Research
Abstract
1) Marcel Kopp - Mechanisms and objective markers of the Spinal Cord Injury-induced Immune Deficiency Syndrome (SCI-IDS) and the impact of infections on outcome after SCI (20 min + 5 min questions)
Respiratory infections are a prevalent and major cause of death during acute care and also in the chronic stage after SCI. The SCI-IDS facilitates the development of infections through decreased host defenses correlated to the neurological level and injury severity independent of other risk factors for pneumonia such as mechanical ventilation¹. Pneumonia acquired during acute care and the first inpatient rehabilitation after SCI is recognized as an outcome modifying factor associated with poorer long-term neurological and functional recovery and a constant increase in mortality.² The SCI-IDS can be objectified by laboratory markers such as HLA-DR expression on monocytes that is significantly decreased after complete or cervical SCI as compared to vertebral trauma patients without SCI. HLA-DR is a key molecule involved in antigen presentation critical for the induction of a specific immune response.
2) James Guest – Epidemiology of infections as prevalent SCI associated complications and challenges for comparative clinical research (20 min + 5 min questions)
Given the limited numbers of subjects enrolled to randomized controlled trials on SCI, observational studies are important to gain sufficient data for clinical research. Prospectively designed registries and observational studies can capture the multiplicity of acute care complications, e.g. the North American Clinical Trials Network, Rick Hansen SCI Registry. Data from these sources have contributed to understanding the epidemiology and clinical relevance of acute care complications.³ However, defining infections may require disease specific approaches as exemplified by consensus recommendations for stroke associated pneumonia. The definition and diagnosis of SCI-associated pneumonia in SCI will be discussed: Are definitions based on clinical criteria, decisions made by clinicians, or diagnostic codes such as ICD-10? How does the data source (administrative versus clinical data) influence the reported incidence and accuracy? Establishing consistent standards for the diagnosis and care of pulmonary complications is essential to improve the quality of SCI-specific pulmonary management, evaluation of treatment efficacy and future clinical studies on immune therapies.
3) James Guest and Marcel Kopp – Expert discussion: Available options for prevention and therapy of pulmonary infections and future targets for immune therapies (20 min + 5 min questions)
We review the evidence for current measures for prevention of respiratory infections such as contact precautions, circumstances of vulnerability (e.g. intubation, mechanical ventilation), the use of antibiotics, and strategies to reduce the individual SCI patient’s susceptibility. In addition, we provide a perspective on current research on immune therapies aiming to modulate the SCI-IDS.⁴
4) Participants and speakers: General discussion (15 min)
Interactive discussion in order to develop an interdisciplinary perspective on how future SCI research, clinical decision-making and medical care regarding pulmonary infections can be improved.
References:
1. Prüss H et al., 2017. Nature Neurosci 20:1549-59.
2. Kopp, MA et al. 2017. Neurology 88:892-900.
3. Grossman RG et al. 2012. J Neurosurg Spine 17:119-128.
4. Noble BT et al. 2018. J Neuroimmunol 321:1-11.
Respiratory infections are a prevalent and major cause of death during acute care and also in the chronic stage after SCI. The SCI-IDS facilitates the development of infections through decreased host defenses correlated to the neurological level and injury severity independent of other risk factors for pneumonia such as mechanical ventilation¹. Pneumonia acquired during acute care and the first inpatient rehabilitation after SCI is recognized as an outcome modifying factor associated with poorer long-term neurological and functional recovery and a constant increase in mortality.² The SCI-IDS can be objectified by laboratory markers such as HLA-DR expression on monocytes that is significantly decreased after complete or cervical SCI as compared to vertebral trauma patients without SCI. HLA-DR is a key molecule involved in antigen presentation critical for the induction of a specific immune response.
2) James Guest – Epidemiology of infections as prevalent SCI associated complications and challenges for comparative clinical research (20 min + 5 min questions)
Given the limited numbers of subjects enrolled to randomized controlled trials on SCI, observational studies are important to gain sufficient data for clinical research. Prospectively designed registries and observational studies can capture the multiplicity of acute care complications, e.g. the North American Clinical Trials Network, Rick Hansen SCI Registry. Data from these sources have contributed to understanding the epidemiology and clinical relevance of acute care complications.³ However, defining infections may require disease specific approaches as exemplified by consensus recommendations for stroke associated pneumonia. The definition and diagnosis of SCI-associated pneumonia in SCI will be discussed: Are definitions based on clinical criteria, decisions made by clinicians, or diagnostic codes such as ICD-10? How does the data source (administrative versus clinical data) influence the reported incidence and accuracy? Establishing consistent standards for the diagnosis and care of pulmonary complications is essential to improve the quality of SCI-specific pulmonary management, evaluation of treatment efficacy and future clinical studies on immune therapies.
3) James Guest and Marcel Kopp – Expert discussion: Available options for prevention and therapy of pulmonary infections and future targets for immune therapies (20 min + 5 min questions)
We review the evidence for current measures for prevention of respiratory infections such as contact precautions, circumstances of vulnerability (e.g. intubation, mechanical ventilation), the use of antibiotics, and strategies to reduce the individual SCI patient’s susceptibility. In addition, we provide a perspective on current research on immune therapies aiming to modulate the SCI-IDS.⁴
4) Participants and speakers: General discussion (15 min)
Interactive discussion in order to develop an interdisciplinary perspective on how future SCI research, clinical decision-making and medical care regarding pulmonary infections can be improved.
References:
1. Prüss H et al., 2017. Nature Neurosci 20:1549-59.
2. Kopp, MA et al. 2017. Neurology 88:892-900.
3. Grossman RG et al. 2012. J Neurosurg Spine 17:119-128.
4. Noble BT et al. 2018. J Neuroimmunol 321:1-11.
Biography
Dr. Kopp has ten years of experience in research on preclinical and clinical aspects of the maladaptive immune response after spinal cord injury and its consequences regarding infections as outcome-modifying factors. This is reflected in over 20 peer-reviewed publications of observational epidemiological work, investigator initiated translational studies, systematic reviews and meta-analyses in biomedical journals as well as more than 50 abstracts or presentations at national or international conferences. After completing his medical studies at Humboldt University Berlin, he joined Prof. Jan Schwab’s Spinal Cord Injury Research laboratory in 2008. Dr. Kopp has received the doctoral degree for his thesis entitled “Inflammatory reaction and immune depression after acute traumatic spinal cord injury and impact of infections on neurological recovery”.
Dr. Kopp is co-group leader of the Spinal Cord Injury Research laboratory at the Department of Neurology and Experimental Neurology at Charité - Universitätsmedizin Berlin, Germany. The Spinal Cord Injury Research laboratory collaborates with the Treatment Centre for Spinal Cord Injuries at the Trauma Hospital Berlin within the Spinal Cord Alliance Berlin, a unique partnership combining natural assets of a non-university, level 1 neurotrauma-center (longitudinal specialized acute and follow-up medical care, patient recruitment) with resources of a university hospital (basic research, trial laboratories, biostatistics) for the conduct of epidemiological and interventional studies. Dr. Kopp is co-affiliated with the Berlin Institute of Health (BIH), QUEST-Center for Transforming Biomedical Research since 2018. At the QUEST-Center he is working with Prof. Ulrich Dirnagl on quality aspects of preclinical and clinical studies in terms of trial design, reporting standards and statistical analysis of observational datasets.
