title: 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.
abstract: 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.
authors: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, , Tokyo, Japan.
authors: Hirotaka
authors: H
authors: Chikuda
authors: Hideo
authors: H
authors: Yasunaga
authors: Katsushi
authors: K
authors: Takeshita
authors: Hiromasa
authors: H
authors: Horiguchi
authors: Hiroshi
authors: H
authors: Kawaguchi
authors: Kazuhiko
authors: K
authors: Ohe
authors: Kiyohide
authors: K
authors: Fushimi
authors: Sakae
authors: S
authors: Tanaka
mesh_terms: D000208:Acute Disease; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone
keywords: Trauma, spine and pelvis; neurology, spinal; spinal