Allostatic load and spinal cord injury: review of existing research and preliminary data

To introduce allostatic load (AL) as a framework for measuring stress-related outcomes after spinal cord injury (SCI) by identifying the number and nature of biomarkers investigated in existing studies and by generating preliminary data on AL in 30 persons with traumatic SCI.

This systematic review and pilot study were conducted at a medical university in the southeastern United States. A review of literature published between 1993 and 2012 identified studies using 2 or more of 5 classes of AL biomarkers. We then collected data on 11 biomarkers (n = 30) from self-selected participants using physical exams and blood and urine specimen collection. These included waist to hip ratio, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, dihydroepiandrosterone, glycosylated hemoglobin, C-reactive protein, interleukin-6, and cortisol, norepinephrine, and epinephrine normalized by 12-hour creatinine.

We were unable to identify any studies investigating AL biomarkers from each of the 5 areas or any studies specifically proposing to investigate AL. AL scores were relatively low, with metabolic indicators being the most elevated and neuroendocrine the least elevated.

AL is a promising, yet underutilized, construct that may be feasibly assessed after SCI.