Risk factors for nosocomial nontraumatic coma: sepsis and respiratory failure

Figures & data

Table 1 Characteristics of the patients with and without NNC

	With NNC (n=96)	Without NNC (n=167)	P-value
Age (years), mean ± SD	58.0±13.6	60.0±14.8	0.291
Female	36 (37.5)	66 (39.5)	0.702
Hypertension	58 (60.4)	91 (54.5)	0.351
Diabetics	11 (11.5)	15 (8.9)	0.517
Atrial fibrillation	2 (2.1)	11 (6.6)	0.105
Hyperlipidemia	61 (63.5)	89 (53.3)	0.106
Intracerebral hemorrhage	44 (43.8)	85 (50.9)	0.429
Cerebral infarction	27 (28.1)	42 (25.1)	0.597
Subarachnoid hemorrhage	11 (11.5)	13 (7.8)	0.319
Encephalitis/meningoencephalitis	4 (4.2)	13 (7.8)	0.251
Septic shock	6 (6.3)	3 (1.8)	0.077
Others	4 (4.2)	11 (6.6)	0.583
Midline shift	45 (46.9)	27 (16.2)	0.000
Basal cisterns compressed	52 (69.8)	23 (13.8)	0.000
Central herniation	46 (47.9)	0 (0)	0.000
Uncal herniation	11 (11.5)	0 (0)	0.000
Mechanical ventilation	27 (28.1)	1 (0.6)	0.000
Mortality in 30 days	65 (67.7)	5 (3)	0.000
Vegetative state	3 (3.1)	0 (0)	0.022
Minimally conscious state	2 (2.1)	0 (0)	0.061

Notes: Data presented as n (%) unless otherwise stated. P-values obtained using a two-tailed t-test.

Abbreviations: NNC, nosocomial nontraumatic coma; SD, standard deviation.

Table 2 The univariate analyses at coma onset in patients with NNC and control subjects

	NNC (N=96)	Control subjects (N=167)	P-value
SIRS-positive sepsis	67 (70.0)	22 (13.2)	0.000a
SIRS-negative sepsis	2 (2.1)	0 (0)	0.061
Acute respiratory failure	29 (30.2)	4 (2.4)	0.000a
Acute renal failure	25 (26.0)	8 (4.8)	0.000a
Hyperglycemia (>7.8 mmol/L)	16 (16.7)	5 (3.0)	0.000a
Hypoglycemia (<2.1 mmol/L)	2 (2.1)	0 (0)	0.061
Severe hyponatremia (<110 mmol/L)	2 (2.1)	1 (0.6)	0.275
Hypernatremia (>150 mmol/L)	8 (8.3)	1 (0.6)	0.001a
Acute seizures	8 (8.3)	8 (4.8)	0.247
Acute hepatic failure	1 (1.0)	0 (0)	0.186
Intracerebral hemorrhage growth	7 (7.3)	2 (1.2)	0.009a
Recurrent subarachnoid hemorrhage	3 (3.1)	1 (0.6)	0.107
Old focal lesion in brain	17 (17.7)	15 (8.9)	0.037b
Brain midline shift	45 (46.9)	27 (16.2)	0.000a
Basal cisterns compressed	52 (69.8)	23 (13.8)	0.000a

Notes:

a P<0.01.

b P<0.05. Data presented as n (%). P-values obtained using a two-tailed t-test.

Abbreviations: NNC, nosocomial nontraumatic coma; SD, standard deviation; SIRS, systemic inflammatory response syndrome.

Table 3 The distribution and source of infection in patients with SIRS-positive sepsis

SIRS-positive sepsis	ICH	CI	SAH	Other	N-AI	C-AI	Death
Primary infection (n=13)							8 (67.5%)
Systemic blood stream (n=6)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	6 (100.0%)	5 (83.3%)
Pneumonia (n=3)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	3 (100.0%)	2 (66.7%)
Encephalitis (n=4)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	4 (100.0%)	1 (25.0%)
Secondary infection (n=54)							32 (50.9%)
Systemic blood stream (n=15)	8 (53.3%)	6 (40.0%)	0 (0)	1 (6.7%)	10 (66.7%)	5 (33.3%)	12 (80.0%)
Pneumonia (n=23)	15 (65.2%)	5 (21.7%)	2 (8.7%)	1 (4.3%)	15 (65.2%)	8 (34.8%)	14 (60.9%)
Tracheobronchial (n=6)	3 (50.0%)	3 (50.0%)	0 (0)	0 (0)	4 (66.7%)	2 (33.3%)	4 (66.7%)
Others (n=10)	4 (40.0%)	4 (40.0%)	1 (10.0%)	1 (10.0%)	7 (70.0%)	3 (30.0%)	2 (20.0%)
All (N=67)	30 (44.8%)	18 (26.9%)	3 (4.5%)	3 (4.5%)	36 (53.7%)	31 (46.2%)	40 (59.7%)

Abbreviations: C-AI, community-acquired infection; CI, cerebral infarction; ICH, intracerebral hemorrhage; N-AI, nosocomial-acquired infection; SAH, subarachnoid hemorrhage; SIRS, systemic inflammatory response syndrome.

Table 4 Multivariate odds ratios for nosocomial nontraumatic coma

	OR	P-value	95% CI for OR
SIRS-positive sepsis	4.008	0.000	1.875–8.567
Acute respiratory failure	3.275	0.047	1.014–10.573

Abbreviations: CI, confidence interval; OR, odds ratio; SIRS, systemic inflammatory response syndrome.