Urinary Biomarkers for Screening High-Risk Urodynamic Phenotypes in Early Spinal Cord Injury: A Pilot Study

Area of Science:

• Urology
• Nephrology
• Neurology

Background:

• Neurogenic bladder (NB) following spinal cord injury (SCI) presents significant morbidity.
• Early characterization of NB post-SCI is limited due to challenges with standard urodynamic studies (UDS).
• Developing noninvasive methods to assess bladder function early after SCI is crucial.

Purpose of the Study:

• To evaluate the potential of urinary biomarkers for identifying high-risk bladder phenotypes in acute SCI.
• To assess the diagnostic performance of individual and panel-based biomarkers.
• To determine if biomarkers can aid in early risk stratification for NB.

Main Methods:

• Prospective cohort study of 45 individuals with acute SCI (≤6 weeks).
• Analysis of nine urinary biomarkers using ELISA in catheter-dependent participants and controls.
• Urodynamic studies (UDS) performed on 35 participants to define high-risk bladder phenotypes (DO, DSD, elevated detrusor pressure, low compliance).

Main Results:

• Individual biomarkers showed moderate discrimination for specific high-risk phenotypes (e.g., NGAL for DO/DSD, RANTES/CCL5 for elevated detrusor pressure).
• A multivariable biomarker panel demonstrated improved detection of high-risk bladder (AUC 0.73).
• The panel achieved high sensitivity (0.94) and negative predictive value (0.92) at an optimized threshold.

Conclusions:

• Urinary biomarkers show promise for noninvasively identifying individuals with early SCI at risk for adverse urodynamic findings.
• This approach could facilitate earlier risk stratification and guide the selective use of UDS in rehabilitation.
• Further validation in larger studies is necessary to establish the clinical utility of these biomarkers.