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2016 ; 9
(2
): 85-94
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English Wikipedia
Nontraumatic spinal cord injury at the neurological intensive care unit:
spectrum, causes of admission and predictors of mortality
#MMPMID27006696
Grassner L
; Marschallinger J
; Dünser MW
; Novak HF
; Zerbs A
; Aigner L
; Trinka E
; Sellner J
Ther Adv Neurol Disord
2016[Mar]; 9
(2
): 85-94
PMID27006696
show ga
OBJECTIVE: Nontraumatic spinal cord injuries (NTSCIs) form a heterogeneous group
of diseases, which may evolve into a life-threatening condition. We sought to
characterize spectrum, causes of admission and predictors of death in patients
with NTSCI treated at the neurological intensive care unit (NICU). METHODS: We
performed a retrospective observational analysis of NTSCI cases treated at a
tertiary care center between 2001 and 2013. Among the 3937 NICU admissions were
93 patients with NTSCI (2.4%). Using multivariate logistic regression analysis,
we examined predictors of mortality including demographics, etiology, reasons for
admission and GCS/SAPS (Glasgow Coma Scale/Simplified Acute Physiology Score)
scores. RESULTS: Infectious and inflammatory/autoimmune causes made up 50% of the
NTSCI cases. The most common reasons for NICU admission were rapidly progressing
paresis (49.5%) and abundance of respiratory insufficiency (26.9%). The mortality
rate was 22.6% and 2.5-fold higher than in the cohort of all other patients
treated at the NICU. Respiratory insufficiency as the reason for NICU admission
[odds ratio (OR) 4.97, 95% confidence interval (CI) 1.38-17.9; p < 0.01], high
initial SAPS scores (OR 1.04; 95% CI 1.003-1.08; p = 0.04), and the development
of acute kidney injury throughout the stay (OR 7.25, 1.9-27.5; p = 0.004) were
independent risk factors for NICU death. CONCLUSIONS: Patients with NTSCI account
for a subset of patients admitted to the NICU and are at risk for adverse
outcome. A better understanding of predisposing conditions and further knowledge
of management of critically ill patients with NTSCI is mandatory.