Admission to Intensive Care Unit due to non-traumatic coma: etiology and outcome

Abstract

Introduction: Non-traumatic coma (NTC) is a common cause of critical illness with diverse etiology and prognosis Aim: To investigate the etiology and outcome of NTC in ICU patients and to explore prognostic factors Methods: In a retrospective study we reviewed the medical records of all patients admitted to the ICU of a teaching hospital due to NTC, from January 2018 to January 2019. Demographic data, medical history, APACHE II score, etiology of coma and ICU mortality were recorded. Results: Among 250 medical records, we identified 30 cases (16 males, mean age 68±14, APACHE II 21±7) of NTC. The etiology of NTC was: intracerebral hemorrhage (8), respiratory failure (6), sepsis (5), post-anoxic (4), CNS infection (3), ischemic stroke (2), metabolic coma (2). Thirteen patients died in the ICU (43%) and 17 were discharged. Sepsis presented the highest ICU mortality (80%), followed by post-anoxic (75%), intracerebral hemorrhage (62%) and ischemic stroke (50%). All patients with respiratory failure, CNS infection and metabolic coma survived to discharge. Sex, age, APACHE II score and history of chronic kidney, respiratory, cardiovascular disease or malignancy were not correlated with ICU mortality (p>0.05). Elevated serum lactate (p:0.018), acute kidney injury (p:0.005) and hypotension (p:0.033) at admission were associated with ICU mortality. Acute kidney injury on the day of admission tripled the risk of death (HR:2.8, 95%CI: 1.2-6.6, p Conclusion: Intracerebral hemorrhage was the leading cause of NTC, followed by respiratory failure and sepsis. Acute kidney injury was the best predictor of ICU mortality.