Causes of death after spinal cord injury in the Czech Republic

Abstract

Study design A retrospective cohort studyObjectives To determine the causes of death in people with spinal cord injury (SCI) admitted to the Spinal Cord Unit (SCU) of the University Hospital Motol from 2004 to 2018. Setting University Hospital Motol, Prague Methods From a cohort of people admitted to the SCU between 2004 and 2018, all deaths were identified based on the database of health insurance companies. The causes of death (ICD-10) were obtained from the Institute of Health Information and Statistics. The standardized mortality ratio (SMR) was calculated for most frequent causes of death.Results During the study period, 990 patients with acute SCI were admitted to the SCU, out of which 183 (18.5%) died. Thirty-five people who had SCI due to cancer were excluded from the study. The leading cause of death in the remaining 148 people was pneumonia, followed by cardiac complications, pulmonary embolism, suicide, and urinary tract infection (UTI). In the group of the individuals who died within 1 year after SCI (N = 41), the main causes of death were pneumonia and pulmonary embolism (17.1% each). Among individuals who survived up to1 year after SCI (N = 107), the most common causes of death were pneumonia (14%) and pressure injuries (12.1%). The cause-specific SMRs were significantly increased for UTI, embolism, pneumonia, and suicide. Conclusion The frequent causes of death in our study group were pressure injuries and suicides. These findings are fundamental to the development and implementation of preventive programs to reduce mortality and increase life expectancy.

Peripheral Immune Dysfunction: A Problem of Central Importance after Spinal Cord Injury

“…Despite a sustained state of inflammation in SCI persons, they experience increased susceptibility to pathogenic infection due to concurrent immunodeficiency ( Figure 1 ). The significance of this is underscored by clinical data examining causes of death in SCI individuals [ 13 , 14 , 15 , 16 ]. The leading cause of death within the first year after a traumatic SCI in the Czech Republic was found to be pneumonia infection (17.1%), with UTIs making up 7.3% of all deaths [ 16 ].…”

“…The significance of this is underscored by clinical data examining causes of death in SCI individuals [ 13 , 14 , 15 , 16 ]. The leading cause of death within the first year after a traumatic SCI in the Czech Republic was found to be pneumonia infection (17.1%), with UTIs making up 7.3% of all deaths [ 16 ]. Pneumonia remained the leading cause of death after a year in the SCI population at 14% of all deaths, with UTIs at 10.3%, pressure ulcers at 12.1%, and sepsis of unknown origin at 6.5%, making infections the leading cause of mortality after SCI at over 40% of all deaths [ 16 ].…”

“…The leading cause of death within the first year after a traumatic SCI in the Czech Republic was found to be pneumonia infection (17.1%), with UTIs making up 7.3% of all deaths [ 16 ]. Pneumonia remained the leading cause of death after a year in the SCI population at 14% of all deaths, with UTIs at 10.3%, pressure ulcers at 12.1%, and sepsis of unknown origin at 6.5%, making infections the leading cause of mortality after SCI at over 40% of all deaths [ 16 ]. In a 70-year study from Britain, the leading cause of death after SCI was respiratory (29.3%) with infections such as pneumonia making up the vast majority of these (23.5% of all deaths) [ 15 ].…”

CCR7-mediated T follicular helper cell differentiation is associated with the pathogenesis and immune microenvironment of spinal cord injury-induced immune deficiency syndrome

“…In a 70-year study in the UK, the major cause of death in SCI patients was infections, such as pneumonia (23.5% of all deaths), with another 7.8% of deaths caused by urinary tract infections and unexplained sepsis (Savic et al, 2017). In the Czech Republic, the cause of death in SCI patients within the first year was peripheral infections (24.4%), and after 1 year, peripheral infections remained the main reason for their death, including pulmonary infections (14%), urinary tract infections (10.3%), sepsis of unknown origin (6.5%), and pressure sores (12.1%) (Kriz et al, 2021). Further, infection and associated hyperthermia can impair central nervous system (CNS) function after SCI (Inamasu et al, 2003;Meisel et al, 2004).…”

Long-Term Survival and Causes of Death in Patients below the Age of 60 with Traumatic Spinal Cord Injury in Germany

“…Although there is some recent retrospective data available from different national-based research projects, these are mainly retrospective descriptions, none of them covering the situation in Germany [ 8 , 14 , 15 , 16 ]. We therefore conducted this registry-based study to explore life expectancy and mortality causes in a large cohort, covering the situation in the north of Germany.…”