Risk Factors for Adverse Drug Reactions of Augmented Mean Arterial Pressure Management After Spinal Cord Injury

Spinal cord injury guidelines recommend a mean arterial pressure (MAP) of 85-90 mmHg for the first 7 d. Vasopressors are often utilized to achieve this, but limited data exist on adverse drug reaction (ADR) development. This study aims to identify risk factors for ADRs among patients with spinal cord injury receiving vasopressors for MAP augmentation.

A 4-y retrospective cohort study included patients aged ≥18 y with a MAP goal ≥85 mmHg who received vasopressors for >24 h. ADRs were defined as myocardial infarction, ischemic stroke, limb ischemia, arrhythmia, tachycardia, and bradycardia. Demographics, neurologic injury, and vasopressor use were collected. Univariate and multivariable analyses were performed.

A total of 117 patients met the inclusion criteria. The cervical spine was the most common level (69.2%). Most patients presented with American Spinal Injury Association A (33.3%). No patients had myocardial infarction, ischemic stroke, or limb ischemia. Fifty-one patients (43.6%) experienced an ADR: bradycardia (26.5%), tachycardia (16.2%), and arrhythmia (10.3%). For all ADRs, norepinephrine use (P = 0.012), days of norepinephrine (P = 0.006), less midodrine use (P = 0.035), and age (P = 0.048) were significant. On multivariable analysis for ADR, age was predictive of ADR (odds ratio [OR] 1.065, confidence interval [CI]: 1.028-1.103, P < 0.001), while midodrine use (OR: 0.027, CI: 0.080-0.862, P = 0.027) and hypertension (OR: 0.098, CI: 0.027-0.351, P ≤ 0.001) were protective. For bradycardia, age was predictive (OR: 1.059, CI: 1.021-1.099, P = 0.002), and hypertension was protective (OR: 0.208, CI: 0.058-0.745, P = 0.016).

Vasopressor augmented MAP management was associated with no thrombotic events. A history of hypertension is protective against ADR.