- •The authors conducted a survival analysis on 222 patients who suffered from severe cervical spinal cord injury (CSCI) in Western China.
- •Survival rates and mortality risk factors were calculated by the product limit (Kaplan-Meier) method and the Cox model.
- •In the current study, the results demonstrated that 4 predictors were closely related to mortality: age, higher neurologic level, ventilator dependence, and treatment options. Timing to surgery is the main risk factor for mortality in patients with CSCIs.
- •Better understanding of the predictors could possibly contribute to the improvement of survival rates.
To assess the survival and the predictors of mortality in patients with severe cervical spinal cord injuries (CSCI).
From January 1, 2010, to May 31, 2018, patients who suffered from severe CSCIs in Western China were enrolled in this study (N=222).
Main Outcome Measures
Survival rates and mortality risk factors. Measures were calculated by the product-limit method (Kaplan-Meier) and the Cox model.
The overall 1-year, 3-year, 5-year, and 8-year postoperative mortalities were 24.4%, 30.6%, 33.3%, 36.2%, and 39.0%, respectively. Most deaths occurred within 36 months after the injury. According to the Cox proportional hazards model, the significant predictors of survival were as follows: (1) age; (2) neurologic level; (3) treatment options (surgical or conservative); (4) ventilator support (P<.05). The 8-year mortality for older patients (>50y) was 50.2%, which was significantly higher than that for younger patients (32.4%, <50y). The risk of death was 2.053 times higher in higher levels of injury (C1-C4) than in lower levels of injury (C5-C8) (P<.05). Compared with conservative treatment, patients who received surgical treatment (either anterior or posterior decompression) had a lower risk of death (P<.05). No significant difference was detected in the risk of death between early surgery (<3d) and mid-term surgery (3-7d) (P>.05). However, patients who received late-term surgery (>7d) had a higher mortality risk (P<.05). The overall 8-year mortality risk of patients who needed ventilator support was much higher than those who did not need ventilator support (P<.05).
Age, neurologic level, ventilator dependence, treatment options, and timing to surgery were main risk factors for mortality in patients with severe CSCIs. Better understanding of the predictors for survival could possibly contribute to the improvement of survival rates.
List of abbreviations:AIS (ASIA Impairment Scale), CSCI (cervical spinal cord injury), RR (risk ratio), SCI (spinal cord injury)
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Published online: January 23, 2019
© 2019 by the American Congress of Rehabilitation Medicine