| Autor: |
Crippa IA; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium., Taccone FS; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium., Wittebole X; Department of Critical Care, Cliniques Universitaires St Luc, UCLouvain, 1200 Brussels, Belgium., Martin-Loeches I; Department of Clinical Medicine, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Wellcome Trust, HRB Clinical Research, St James's University Hospital Dublin, D08 NHY1 Dublin, Ireland.; Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, 08036 Barcelona, Spain., Schroeder ME; Division of Trauma and Critical Care Surgery, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI 53226, USA., François B; Intensive Care Unit and Inserm CIC 1435 & UMR 1092, Dupuytren University Hospital, 87000 Limoges, France., Kotfis K; Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland., Ñamendys-Silva SA; Department of Critical Care Medicine, Instituto Nacional de Cancerología, Ciudad de México 14080, Mexico.; Division of Pulmonary, Anesthesia and Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico., Forceville X; Medico-Surgical Intensive Care Unit, Great Hospital of East Francilien-Meaux Site, Hôpital Saint Faron, 77100 Meaux, France.; Clinical Investigation Center (CIC Inserm 1414), CHU de Rennes-Université de Rennes, 35033 Rennes, France., Solé-Violán J; Intensive Care Unit, University Hospital of GC Dr Negrín, 35010 Las Palmas, Gran Canaria, Spain., Fontes LE; Departamento de Medicina Baseada em Evidências, Medicina Intensiva, Urgência e Emergência-Faculdade de Medicina de Petrópolis, 25680-120 Petrópolis, Brazil., Vincent JL; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium., On Behalf Of The Icon Investigators |
| Abstrakt: |
Brain dysfunction is associated with poor outcome in critically ill patients. In a post hoc analysis of the Intensive Care over Nations (ICON) database, we investigated the effect of brain dysfunction on hospital mortality in critically ill patients. Brain failure was defined as a neurological sequential organ failure assessment (nSOFA) score of 3-4, based on the assumed Glasgow Coma Scale (GCS) score. Multivariable analyses were performed to assess the independent roles of nSOFA and change in nSOFA from admission to day 3 (ΔnSOFA) for predicting hospital mortality. Data from 7192 (2096 septic and 5096 non-septic) patients were analyzed. Septic patients were more likely than non-septic patients to have brain failure on admission (434/2095 (21%) vs. 617/4665 (13%), p < 0.001) and during the ICU stay (625/2063 (30%) vs. 736/4665 (16%), p < 0.001). The presence of sepsis (RR 1.66 (1.31-2.09)), brain failure (RR 4.85 (3.33-7.07)), and both together (RR 5.61 (3.93-8.00)) were associated with an increased risk of in-hospital death, but nSOFA was not. In the 3280 (46%) patients in whom ΔnSOFA was available, sepsis (RR 2.42 (1.62-3.60)), brain function deterioration (RR 6.97 (3.71-13.08)), and the two together (RR 10.24 (5.93-17.67)) were associated with an increased risk of in-hospital death, whereas improvement in brain function was not. |
