The effect of steroids on the incidence of gastrointestinal hemorrhage after spinal cord injury: A case-controlled study

M. F. Khan, S. S. Burks, H. Al-Khayat, A. D. Levi

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Study design:Retrospective case-controlled study.Objectives:To understand the incidence of gastrointestinal hemorrhage (GIH) and subsequent mortality rate associated with steroid use after acute spinal cord injury (SCI).Setting:Miami, Florida, USA.Methods:This case-controlled study investigates two sequential study groups with SCI treated by a single surgeon in a level I trauma center. The first study cohort (1997-2005) received steroids according to the NASCIS II protocol and the second (2005-2012) received no steroid treatment. The groups were comparable with respect to age, sex, severity and level of injury (43 vs 45 years old/3:1 male-female/AIS scale % - 43.5 vs 41.7 A, 10.6 vs 11.1 B, 20.3 vs 13.4 C, 25.4 vs 33.5 D/64.3 vs 73.8% cervical, 35.6 vs 25.7% thoracic and lumbar). The incidence and mortality from GIH were the primary outcome measures.Results:A total of 350 patients were evaluated during the study period. The incidence of GIH in the SCI group receiving steroids was 6/216 (2.77%) with 2 mortalities (33.3%). No gastrointestinal (GI) complications were noted in the 134 patients that did not receive any steroids (P=0.086). All GIH cases in the steroid group were in cervical SCI patients - 6/139 (4.32%; P=0.043). Average time to onset of GIH was 16 days.Conclusion:The use of steroids in acute SCI appears to be a key risk factor in increasing the incidence of clinically overt GI complications with a subsequent high mortality rate, particularly in patients with cervical SCI.

Original languageEnglish (US)
Pages (from-to)58-60
Number of pages3
JournalSpinal Cord
Volume52
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • gastrointestinal hemorrhage
  • GI bleeding
  • Spinal cord injury
  • steroids

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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