Anemia and hypoalbuminemia of chronic spinal cord injury: prevalence and prognostic significance

Study design: The study was a retrospective analysis. Objective: The objective of the study was to survey a chronic spinal cord injury (SCI) population for the prevalence and prognostic significance of anemia (AN) and hypoalbuminemia (HA). Setting: The study was conducted at VA Boston Healthcare System, USA. Methods: A review of records of 322 SCI subjects (318 males) scheduled for annual examination was carried out for the period from 1998 to 2007. The number of follow-up years with AN (hematocrit <40%) or severe anemia (SAN) (hematocrit <30%) or HA (serum albumin <3 g%) was recorded for all subjects, divided between survivor and deceased subjects. Results: A total of 239 subjects survived to an average age of 60 and 30 years of paralysis and 83 subjects died at an average age of 70 and 27 years of paralysis (P<0.01 and P<0.06, respectively). The level and grade of paralysis were similar in these groups. The average prevalence rates of AN, SAN and HA were 34, 6 and 6% of survey years in the survivor group and 83, 18 and 22% in the deceased group; the respective ratios were 2.4, 3.0 and 3.7 (P<0.001). The fractions of survey years that were positive for SAN and/or HA among causes of death were sepsis, 42%; cancer, 33%; pulmonary failure 30%; cardiovascular disease, 25%; and undetermined causes, 9%. The mortality rate for the 95 subjects with a recurrence of SAN or HA was 40% within 3 years. Conclusion: The prevalence of AN, SAN and HA among chronic SCI subjects is high; repeated SAN and HA often precede death, particularly due to sepsis. Spinal Cord (2010) 48, 566-569; doi:10.1038/sc.2009.163; published online 1 December 2009