Lesión medular aguda traumática por encima de T6epidemioloxía e impacto da disfunción de órganos na mortalidade e estancia en UCI

Abstract

Objectives: To characterise the patients admitted to the Intensive Care Unit (ICU) with acute traumatic spinal cord injury (TSCI) above the T6 level, including mortality, hospital admission length, and the prognostic value of the SOFA organ dysfunction scale. Methods: Retrospective observational study of patients with acute TSCI above T6 admitted to the ICU at the Complexo Hospitalario Universitario de A Coruña between 1998 - 2017 (n = 241). Results: Age, the Charlson index and APACHE II scores at admission increased during the study period in association with a reduction in patient admission lengths in the ICU. There were no changes in the intra-ICU (12.4 %) or hospital (23.7 %) mortality rates during this study period in our cohort. The intra-ICU mortality predictor variables were age (OR = 1.05), SOFA day 0 (OR = 1.42), ΔSOFA 4 – 0 (OR = 1.53), and fluid balance on day four (OR = 1.16); 29.4 % remai¬ned hospitalised in the ICU for ≥ 30 days, with a prolonged stay not being associated with higher post-discharge mortality (HR = 0.80; p = 0.699). A higher ASIA motor sco¬re (sub-distribution hazard ratio [sHR] = 1.01), lower SOFA score (sHR = 0.82), lower fluid balance on the fourth day (sHR = 0.95), and the absence of infection were asso¬ciated with shorter ICU stays. Conclusions: This work showed an epidemiological change in our hospital context and also demonstrated the effect of organ dysfunction and fluid balance on patient mortality and length of ICU stays.