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. 2016 Mar;9(2):85-94.
doi: 10.1177/1756285615621687. Epub 2015 Dec 11.

Nontraumatic spinal cord injury at the neurological intensive care unit: spectrum, causes of admission and predictors of mortality

Lukas Grassner  1 , Julia Marschallinger  2 , Martin W Dünser  3 , Helmut F Novak  4 , Alexander Zerbs  4 , Ludwig Aigner  2 , Eugen Trinka  4 , Johann Sellner  5
Affiliations

Nontraumatic spinal cord injury at the neurological intensive care unit: spectrum, causes of admission and predictors of mortality

Lukas Grassner et al. Ther Adv Neurol Disord. 2016 Mar.

Abstract

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.

Keywords: intensive care; mortality; nontraumatic spinal cord injury; treatment.

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Conflict of interest statement

Conflict of interest statement: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Grassner reports no disclosures. Dr Marschallinger reports no disclosures. Dr Dünser reports no disclosures. Dr Novak has received speakers’ honoraria from Astellas and CSC Angelini Pharmaceuticals, He has no specific conflicts relevant to this work. Dr Zerbs reports no disclosures. Dr Aigner reports no disclosures. Dr Trinka has received research funding from UCB Pharma, Biogen-Idec, Red Bull, Merck, the European Union, FWF Österreichischer Fond zur Wissenschaftsförderung, and Bun-desministerium für Wissenschaft und Forschung and has acted as a paid consultant to Eisai, Takeda, Ever Neuropharma, Biogen, Bial, Sunovion, and UCB, and has received speakers’ honoraria from Bial, Eisai, GL Lannacher, GlaxoSmithKline, Boehringer, Sunovion, Newbridge Pharma, and UCB Pharma. He has no specific conflicts relevant to this work. Dr Sellner received research funding from the Paracelsus Medical University, Bayer, Biogen-Idec, Merck and Novartis, has acted as paid consultant to Novartis and Genzyme, and has received speakers’ honoraria from Biogen-Idec, Ever Neuropharma, Genzyme, Novartis and Teva-Ratiopharm. He has no specific conflicts relevant to this work

Figures

Figure 1.
Figure 1.
NTSCI on NICU algorithm. Distribution of different subgroups and their diagnoses are indicated. ADEM, acute disseminated encephalomyelitis; AVM, arteriovenous malformation; NTSCI, nontraumatic spinal cord injury; NICU, neurological intensive care unit.
See this image and copyright information in PMC

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