Routine Blood Tests Provide Early Insights for Spinal Cord Injury Recovery

A new study led by researchers at the University of Waterloo suggests that routine hospital blood tests may offer early indicators of injury severity and mortality risk following spinal cord trauma.

The research is published in npj Digital Medicine. 

Variability complicates early prognosis

Spinal cord injury presents significant diagnostic challenges, especially in emergency and intensive care settings. The clinical course can vary substantially between individuals, and the need for rapid decision-making often limits access to objective neurological assessments, which depend on patient responsiveness and are not always feasible in the early hours post-injury.

Using data from over 2,600 patients treated in the United States, the researchers explored how daily blood test results – collected during the first three weeks of hospital care – could be used to predict the outcomes of spinal cord injury (SCI). The team applied machine learning algorithms to identify patterns in standard blood measurements such as electrolyte levels and immune cell counts.

The study showed that blood-based predictive models could provide valuable clinical insights, particularly in the absence of early neurological data. These models successfully forecasted both injury severity and survival outcomes within the first 72 hours of hospital admission. Accuracy improved further as additional data accumulated over time.

“Routine blood tests could offer doctors important and affordable information to help predict risk of death, the presence of an injury and how severe it might be,” said Dr. Abel Torres Espín, a professor in Waterloo’s School of Public Health Sciences.  

Beyond imaging and omics

While other diagnostic tools such as magnetic resonance imaging (MRI) and molecular biomarkers derived from blood or cerebrospinal fluid (omics-based biomarkers) can also inform clinical decisions, they are not universally available or affordable. In contrast, routine blood tests are part of standard hospital care and are consistently available across healthcare systems.

The routine nature of blood testing can also be advantageous, as this provides multiple datapoints for study.

“While a single biomarker measured at a single time point can have predictive power, the broader story lies in multiple biomarkers and the changes they show over time,” said Dr. Marzieh Mussavi Rizi, a postdoctoral scholar in Torres Espín’s lab at Waterloo. 

Improving critical care resource use

Early and accurate estimation of SCI severity has implications for clinical management, both in terms of how the injury treatment is performed and how healthcare resources are allocated. According to the researchers, models based on blood tests may help determine whether an injury is motor complete or incomplete, a classification with significant therapeutic implications.

“Prediction of injury severity in the first days is clinically relevant for decision-making, yet it is a challenging task through neurological assessment alone,” Torres Espín said. “This foundational work can open new possibilities in clinical practice, allowing for better-informed decisions about treatment priorities and resource allocation in critical care settings for many physical injuries.” 

Reference: Mussavi Rizi M, Fernández D, Kramer JLK, et al. Modeling trajectories of routine blood tests as dynamic biomarkers for outcome in spinal cord injury. npj Digit Med. 2025;8(1):470. doi: 10.1038/s41746-025-01782-0

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