Elsevier

Injury

Volume 39, Issue 7, July 2008, Pages 748-752
Injury

Early complications of high-dose methylprednisolone in acute spinal cord injury patients

https://doi.org/10.1016/j.injury.2007.12.005Get rights and content

Summary

Background

To evaluate the early complications and effect on neurological outcome of methylprednisolone (MP) treatment in spinal cord injury (SCI) patients during the acute phase.

Methods

We retrospectively reviewed the whole cohort of patients admitted to our ICU between January 1994 and December 2005 due to acute SCI. Patients were grouped according to the medical treatment received (MP group versus no-MP group). Patient data as age, gender, Glasgow coma score (GCS), APACHE II, injury severity score (ISS) and ICU stay were recorded. Outcome at ICU discharge and neurological function based on Frankel grade was recorded at ICU admission and at ICU discharge. Early complications were also noted.

Results

There were no differences between both groups in ICU mortality (OR = 0.48; 95% CI: 0.08–3.64) nor neurological function at ICU discharge. (OR = 1.09; 95% CI: 0.35–3.66). MP group presented an increase in respiratory tract infections (OR = 8.19; 95% CI: 1.10–358.6) and in total infections (OR = 4.90; 95% CI: 1.46–18.83) compared to no-MP group during the ICU stay. There was a significant increase in the incidence of hyperglycaemia in the MP group (OR = 17.0; 95% CI: 4.52–66.3).

Conclusions

: The use of MP in patients with acute SCI is not associated with an improvement in outcome or neurological function at ICU discharge. Moreover, the use of MP is associated with an increased risk of infectious and metabolic complications during ICU stay.

Introduction

Few conditions are as devastating as traumatic spinal cord injury (SCI). This type of injury is a major cause of morbidity in young individuals and as a result has a major impact on society as a whole.11 During most of the last century, the management of acute SCI has traditionally concentrated on preventive measures as well as conservative care.

In 1990, Bracken et al.1 first reported the effectiveness of methylprednisolone (MP) treatment in recovery from SCI. After this study the use of intravenous high-dose MP in acute SCI became a standard aspect of care in these patients. A number of published critiques of the NASCIS II data and their presentation in support of the use of MP in the management of patients with acute SCI have been offered. Over the past 10 years, a lively debate has ensued in the literature over whether or not steroids should be used at all in SCI. Many authors have tried to further distil and objectify the results of the NASCIS studies, most with unfavourable conclusions.12, 20 Moreover, some authors have suggested that the use of high-dose MP in acute SCI is associated with an increase in complications.14, 19 Finally, the American Association of Neurological Surgeons Joint Section of Disorders of the Spine and Peripheral Nerves recommended the use of MP only as an option, not as a guideline or standard.17 Despite these considerations, many physicians continue to prescribe methylprednisolone for acute SCI even today.2, 13

We aimed to review the outcome of patients admitted to our intensive care unit (ICU) with SCI from 1994 to 2005, according to the use or not of MP (NASCIS II protocol).

Section snippets

Patients and methods

We retrospectively reviewed the whole cohort of patients admitted to our ICU between January 1994 and December 2005 due to SCI. Eligible patients were those who were older than 14 years and ICU hospitalisation within 8 h of vertebral trauma with spinal cord involvement. Patients were grouped according to the medical treatment received. Those patients who received MP according to NASCIS II protocol were considered as MP group, and patients who did not receive MP were considered as no-MP group. MP

Results

There were 59 patients in the MP group and 23 patients in the No-MP group. There was no significant difference in sex ratio or age between the groups (Table 1). All patients had a neurological deficit of varying degrees according to Frankel scale at ICU admission, and there was no difference between the groups (Table 2).

There were no differences between both groups in ICU mortality. Four patients died in MP group (6.7%) and 3 patients in No-MP group (13%) (OR = 0.48; 95% CI: 0.08–3.64). There

Discussion

The hope that administration of a drug delivered after acute SCI might improve neurological function has long been held. Although other substances, as naloxone and GM-1 ganglioside, have been tested in laboratory and in clinical investigations, corticosteroids, particularly methylprednisolone, have been the most extensively studied drugs in animal and human studies.10, 17 The precise mechanism of action is not completely known, but corticosteroids have the potential to stabilise membrane

Conflict of interest

None.

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