Mortality and morbidity after high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury: a propensity-matched analysis using a nationwide administrative database
- Hirotaka Chikuda1,
- Hideo Yasunaga2,
- Katsushi Takeshita1,
- Hiromasa Horiguchi2,
- Hiroshi Kawaguchi1,
- Kazuhiko Ohe3,
- Kiyohide Fushimi4,
- Sakae Tanaka1
- 1Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- 2Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- 3Department of Medical Informatics and Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- 4Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan
- Correspondence to Dr Hirotaka Chikuda, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;
- Received 8 October 2012
- Revised 18 December 2012
- Accepted 19 December 2012
- Published Online First 28 February 2013
Objective To examine the magnitude of the adverse impact of high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury (SCI).
Methods We examined the abstracted data from the Japanese Diagnosis Procedure Combination database, and included patients with ICD-10 code S141 who were admitted on an emergency basis between 1 July and 31 December in 2007–2009. The investigation evaluated the patients’ sex, age, comorbidities, Japan Coma Scale, hospital volume and the amount of methylprednisolone administered. One-to-one propensity-score matching between high-dose methylprednisolone group (>5000 mg) and control group was performed to compare the rates of in-hospital death and major complications (sepsis; pneumonia; urinary tract infection; gastrointestinal ulcer/bleeding; and pulmonary embolism).
Results We identified 3508 cervical SCI patients (2652 men and 856 women; mean age, 60.8±18.7 years) including 824 (23.5%) patients who received high-dose methylprednisolone. A propensity-matched analysis with 824 pairs of patients showed a significant increase in the occurrence of gastrointestinal ulcer/bleeding (68/812 vs 31/812; p<0.001) in the high-dose methylprednisolone group. Overall, the high-dose methylprednisolone group demonstrated a significantly higher risk of complications (144/812 vs 96/812;OR, 1.66; 95% CI 1.23 to 2.24; p=0.001) than the control group. There was no significant difference in in-hospital mortality between the high-dose methylprednisolone group and the control group (p=0.884).
Conclusions Patients receiving high-dose methylprednisolone had a significantly increased risk of major complications, in particular, gastrointestinal ulcer/bleeding. However, high-dose methylprednisolone treatment was not associated with any increase in mortality.
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