title: Nontraumatic spinal cord injury at the neurological intensive care unit: spectrum, causes of admission and predictors of mortality.
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.
authors.affiliation: Center for Spinal Cord Injuries, BG Trauma Center Murnau, Germany Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Grassner
authors.affiliation: Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Marschallinger
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and General Intensive Care Medicine, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Helmut F
authors.initials: HF
authors.lastname: Novak
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zerbs
authors.affiliation: Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Aigner
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, A-5020 Salzburg, Austria.
authors.forename: Johann
authors.initials: J
authors.lastname: Sellner
keywords: intensive care; mortality; nontraumatic spinal cord injury; treatment