Research Reports - Impact of non-neurological complications in severe traumatic brain injury outcome
Crit Care. 2012 Dec 12;16(2):R44
Corral L, Javierre CF, Ventura JL, Marcos P, Herrero JI, Mañez R
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).