Factors predicting intensive care unit mortality in acute traumatic spinal cord injuries: A retrospective analysis

Aim: To identify demographic, clinical, and metabolic predictors of mortality in patients with acute traumatic spinal cord injury admitted to a tertiary-level intensive care unit and to evaluate their impact on prognosis.Methods: The study included 128 patients admitted to the ICU with a diagnosis of traumatic spinal cord injury between January 2015 and January 2024. Patients’ demographic characteristics, injury etiologies, Injury Severity Score, Glasgow Coma Scale (GCS), serum lactate levels at admission, and mean arterial pressure values during hospitalization were retrospectively analyzed. Groups were stratified according to mortality status (survivors and deceased). Independent risk factors were identified using multivariate logistic regression analysis.Results: The mean age of the study population was 34.65 ± 12.33 years, and 78.1% of patients (n = 100) were male. The overall mortality rate was 24.2% (n=31). In the deceased group, the proportion of patients with a serum lactate level ≥2 mmol/L at admission (77.4%) was significantly higher than in the surviving group (20.6%) (p < 0.001). It was observed that MAP targets (≥85 mmHg) were not achieved in 71% of patients in the mortality group (n=22) (p < 0.001). The need for mechanical ventilation was found to be statistically significantly higher in patients with cervical injuries (57.6%) compared to those with thoracic and lumbar injuries (p < 0.001). In the multivariate analysis, a low GCS score was identified as the sole independent risk factor for mortality (OR: 0.521; 95% CI: 0.275 – 0.987; p = 0.045).Conclusion: In the management of acute traumatic spinal cord injury, hyperlactemia at admission (≥2 mmol/L), a low GCS score, and low MAP during the first 24 hours are the strongest predictors of intensive care mortality. In particular, the high need for respiratory support observed in cervical-level injuries underscores the importance of aggressive perfusion optimization and airway management in this patient group.