Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study
| العنوان: | Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study |
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| المؤلفون: | Jacquelyn J. Cragg, Armin Curt, Stephanie C. Knüpfer, Martin Schubert, Marc P. Schneider, Matthias Walter, Lorenz Leitner, Thomas M. Kessler, Ulrich Mehnert, Andrei V. Krassioukov |
| المساهمون: | University of Zurich, Kessler, Thomas M |
| المصدر: | BMC Medicine, Vol 16, Iss 1, Pp 1-11 (2018) BMC Medicine |
| بيانات النشر: | Springer Science and Business Media LLC, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Male, Urinary system, 030232 urology & nephrology, lcsh:Medicine, 610 Medicine & health, Neurogenic detrusor overactivity, Spinal cord injury, 2700 General Medicine, Autonomic dysreflexia, Cohort Studies, Lesion, 03 medical and health sciences, 0302 clinical medicine, Urodynamic investigation, Humans, Medicine, Prospective Studies, Prospective cohort study, Stroke, business.industry, lcsh:R, Neurogenic lower urinary tract dysfunction, General Medicine, Odds ratio, Middle Aged, Spinal cord, medicine.disease, Urodynamics, medicine.anatomical_structure, Anesthesia, Female, 10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center, medicine.symptom, Prediction, business, 030217 neurology & neurosurgery, Research Article |
| الوصف: | Background: Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia. Therefore, we aimed to determine predictors of autonomic dysreflexia in individuals with spinal cord injury during urodynamic investigation. Methods: This prospective cohort study included 300 patients with spinal cord injuries and complete datasets of continuous non-invasive cardiovascular monitoring, recorded during same session repeat urodynamic investigation. We used logistic regression to reveal predictors of autonomic dysreflexia during urodynamic investigation. Results: We found that level of injury and presence of neurogenic detrusor overactivity were the only two independent significant predictors for autonomic dysreflexia during urodynamic investigation. A lesion at spinal segment T6 or above (odds ratio (OR) 5.5, 95% CI 3.2–9.4) compared to one at T7 or below, and presence of neurogenic detrusor overactivity (OR 2.7, 95% confidence interval (CI) 1.4–4.9) were associated with a significant increased odds of autonomic dysreflexia during urodynamic investigation. Both odds persisted after adjustment for age, sex, and completeness and stage of injury (adjusted OR (AOR) 6.6, 95% CI 3.8–11.7, and AOR 2.2, 95% CI 1.1–4.5, respectively). Further stratification by lesion level showed level-dependent significantly increased adjusted odds of autonomic dysreflexia, i.e., from C1–C4 (AOR 16.2, 95% CI 5.9–57.9) to T4–T6 (AOR 2.6, 95% CI 1.3–5.2), compared to lesions at T7 or below. Conclusions: In patients with neurogenic lower urinary tract dysfunction due to spinal cord injury, autonomic dysreflexia is independently predicted by lesion level and presence of neurogenic detrusor overactivity. Considering the health risks associated with autonomic dysreflexia, such as seizures, stroke, retinal bleeding, or even death, we recommend both continuous cardiovascular monitoring during urodynamic investigation in all spinal cord-injured patients with emphasis on those with cervical lesions, and appropriate neurogenic detrusor overactivity treatment to reduce the probability of potentially life-threatening complications. Trial registration ClinicalTrials.gov, NCT01293110 . |
| وصف الملف: | 12916_2018_Article_1040.pdf - application/pdf |
| تدمد: | 1741-7015 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f3616a4504f54cc83d65e935b8d42781Test https://doi.org/10.1186/s12916-018-1040-8Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....f3616a4504f54cc83d65e935b8d42781 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 17417015 |
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