Research Reports - Impact of non-neurological complications in severe traumatic brain injury outcome
Luisa Corral, Casimiro F Javierre, Josep L Ventura, Pilar Marcos, Jose I Herrero and Rafael Manez
Critical Care 2012, 16:R44
Non-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with severe TBI admitted to the Intensive Care Unit (ICU), the impact of these complications on mortality, and their possible correlation with TBI severity.
Observational retrospective cohort study, in one multidisciplinary intensive care unit of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale [GCS] < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded.
Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (PaO2/FiO2 <200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that GOS at 1 year was independently associated with age, initial GCS 3-5, worst Traumatic Coma Data Bank (TCDB) first Computed Tomography (CT) scan and presence of intracranial hypertension, not AKI. And, hospital mortality was independently associated with initial GSC 3-5, worst TCDB first CT scan, presence of intracranial hypertension and AKI. Presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% CI: 1.37-27.78) (p<0.02), whilst ICU hypotension increased the risk of death in patients with initial scores of 3-5 on the GCS 4.28 times (95% CI: 1.22-15.07) (p<0.05).
Low initial GCS, worst first CT scan, intracranial hypertension and acute kidney injury determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These adds to previous studies that non-neurological complications increase length of stay and morbidity in ICU, but does not increase mortality, with the exception of AKI and hypotension in low GCS (3-5).« Back to Special Reports