Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/23304
Title: Impact of non-neurological complications in severe traumatic brain injury outcome
Author: Corral, Luisa
Javierre Garcés, Casimiro F.
Ventura i Farré, Josep Lluís
Marcos, Pilar
Herrero, Jose
Manez, Rafael
Keywords: Traumatismes cranials
Fisiologia patològica
Skull injuries
Pathological physiology
Issue Date: 30-Mar-2012
Publisher: BioMed Central Ltd
Abstract: Introduction: 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 ICU, the impact of these complications on mortality, and their possible correlation with TBI severity. Methods An observational retrospective cohort study was conducted in one multidisciplinary ICU 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. Results Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (arterial oxygen pressure/oxygen inspired fraction ratio (PaO2/FiO2) < 200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that Glasgow Outcome Score (GOS) at one year was independently associated with age, initial GCS 3 to 5, worst Traumatic Coma Data Bank (TCDB) first computed tomography (CT) scan and the presence of intracranial hypertension but not AKI. Hospital mortality was independently associated with initial GSC 3 to 5, worst TCDB first CT scan, the presence of intracranial hypertension and AKI. The presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% confidence interval (CI): 1.37 to 27.78) (P < 0.02), while ICU hypotension increased the risk of death in patients with initial scores of 3 to5 on the GCS 4.28 times (95% CI: 1.22 to15.07) (P < 0.05). Conclusions Low initial GCS, worst first CT scan, intracranial hypertension and AKI 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 findings add to previous studies that showed that non-neurological complications increase the length of stay and morbidity in the ICU but do not increase mortality, with the exception of AKI and hypotension in low GCS (3 to 5).
Note: Reproducció del document publicat a: http://dx.doi.org/10.1186/cc11243
It is part of: Critical Care 2012, 16:R44
Related resource: http://dx.doi.org/10.1186/cc11243
URI: http://hdl.handle.net/2445/23304
ISSN: 1364-8535
Appears in Collections:Articles publicats en revistes (Ciències Fisiològiques)

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