World neurosurgery 2017 07 12() pii S1878-8750(17)31090-2
Anxiety or depression (AD) is a common complication after traumatic spinal cord injury (tSCI). This study sought to investigate the role of pre-existing hyperlipidemia in new-onset AD after tSCI using a longitudinal population database.
This retrospective cohort study used Longitudinal Health Insurance Database data from January 1997 to December 2011. The case and comparison groups were individuals who experienced tSCI and who did and did not have pre-existing hyperlipidemia, respectively. Kaplan-Meier curves were plotted, and log-rank test was used to compare the differences between these two groups. A Cox regression model was used to estimate the relative risk of anxiety or depression.
Of 26892 adult patients were enrolled in this study. After 1:3 matching with age and gender, it showed (1) tSCI patients with pre-existing hyperlipidemia have a 1.32-fold adjusted hazard ratio compared with those without hyperlipidemia (p<0.05); (2) The Kaplan-Meier plot in tSCI patients with hyperlipidemia were more likely to develop the new-onset AD than those without hyperlipidemia during the follow-up period (p=0.0003); and (3) the stratified analysis showed the risk of AD among tSCI patients aged at 18∼34 years (HR: 3.2; 95% C.I.: 1.2-8.9), male patients (HR: 1.3; 95% C.I.: 1.1-1.6), and higher Charlson's comorbidity index (CCI) score (CCI>2, HR: 1.9; 95% C.I.: 1.2-2.9), and those with a history of stroke history (HR: 1.7; 95% C.I.: 1.0-2.7) CONCLUSIONS: Pre-existing hyperlipidemia is an independent predictor of new-onset AD in tSCI patients, especially in those who are younger, male, have a higher CCI score, and have stroke.