Risk factors for nosocomial nontraumatic coma: sepsis and respiratory failure

Abstract

Background

Coma’s are a major cause of clinical deterioration or death. Identification of risks that predispose to coma are important in managing patients; however, the risk factors for nosocomial nontraumatic coma (NNC) are not well known. Our aim was to investigate the risk factors in patients with NNC.

Methods

A retrospective case–control design was used to compare patients with NNC and a control group of patients without coma in a population-based cohort of 263 participants from the neurological intensive care unit in Shuyang County People’s Hospital of Northern China. Coma was diagnosed by a Glasgow Coma Scale score ≤8. Adjusted odds ratios for patients with NNC were derived from multivariate logistic regression analyses.

Results

A total of 96 subjects had NNC. The prevalence of NNC was 36.5% among the subjects. Among these, 82% had acute cerebrovascular etiology. Most of the NNC usually occurred at day 3 after admission to the neurological intensive care unit. Patients with NNC had higher hospital mortality rates (67.7% vs 3%, P<0.0001) and were more likely to have a central herniation (47.9% vs 0%, P<0.001) or uncal herniation (11.5% vs 0%, P<0.001) than those without NNC. Multiple logistic regression showed that systemic inflammatory response syndrome-positive sepsis (odds ratio =4, 95% confidence interval =1.875−8.567, P<0.001) and acute respiratory failure (odds ratio =3.275, 95% confidence interval =1.014−10.573, P<0.05) were the factors independently associated with a higher risk of NNC.

Conclusion

Systemic inflammatory response syndrome-positive sepsis and acute respiratory failure are independently associated with an increased risk of NNC. This information may be important for patients with NNC.

Keywords:

• nosocomial nontraumatic coma
• infection
• sepsis
• acute respiratory failure
• GCS

Acknowledgments

This work was supported by a grant from the Medical Research Council, Affiliated Shuyang People’s Hospital, XuZhou Medical University, People’s Republic of China. This study was funded by the Clinical Key Specialty Construction Project of Jiangsu Provience (20160017), People’s Republic of China

Disclosure

The authors report no conflicts of interest in this work.