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

In 30 seconds

This prospective cohort pilot study assessed whether urinary biomarkers could identify adverse urodynamic phenotypes early after spinal cord injury. It included 45 people with acute SCI (≤ 6 weeks post-injury); 35 catheter-dependent participants underwent urodynamic studies, while 10 spontaneously voiding participants served as controls without UDS. Individual biomarkers showed moderate discrimination, and a multivariable panel identified high-risk bladder phenotypes with an AUC of 0.73 (95% CI 0.59-0.89). At a sensitivity-optimized threshold, sensitivity was 0.94 and negative predictive value was 0.92. The findings suggest potential for risk stratification, but require validation in larger studies.

Key findings

• NGAL discriminated detrusor overactivity with an AUC of 0.75 and detrusor sphincter dyssynergia with an AUC of 0.84.
• RANTES/CCL5 discriminated elevated detrusor pressure with an AUC of 0.73.
• The multivariable panel had an AUC of 0.73 (95% CI 0.59-0.89); at the sensitivity-optimized threshold, sensitivity was 0.94, negative predictive value 0.92, and negative likelihood ratio 0.16.
• Model discrimination was preserved after accounting for urinary inflammation, although individual biomarkers differed in sensitivity.

Why it matters

Adverse bladder findings can occur early after SCI, while access to or routine use of urodynamic studies may be limited. A noninvasive biomarker approach could help identify people who may warrant closer assessment and support targeted use of UDS. The reported performance is promising, particularly for ruling out high-risk findings at the selected threshold, but does not establish that biomarkers can replace urodynamic evaluation.

What to keep in mind

This was a pilot cohort of 45 participants, and only 35 underwent UDS. The authors state that larger studies are needed to validate the findings and define the clinical role of biomarkers.