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. 2021 Apr 23;11(5):530.
doi: 10.3390/brainsci11050530.

The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit

Ilaria A Crippa  1 , Fabio S Taccone  1 , Xavier Wittebole  2 , Ignacio Martin-Loeches  3   4 , Mary E Schroeder  5 , Bruno François  6 , Katarzyna Kotfis  7 , Silvio A Ñamendys-Silva  8   9 , Xavier Forceville  10   11 , Jordi Solé-Violán  12 , Luis E Fontes  13 , Jean-Louis Vincent  1 , On Behalf Of The Icon Investigators
Affiliations

The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit

Ilaria A Crippa et al. Brain Sci. .

Abstract

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.

Keywords: Glasgow Coma Scale; ICU; brain function; outcome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Intensive care unit (ICU) and hospital mortality in septic and non-septic patients, according to the neurological sequential organ failure assessment (nSOFA) score on admission and the worst nSOFA during the ICU stay. * p < 0.05.
Figure 2
Figure 2
Adjusted risk of hospital mortality (multivariable analysis) according to the presence of sepsis and/or brain failure (BF), using non-septic patients without brain failure as reference (REF). Data are expressed as adjusted risk ratios and 95% confidence intervals.
Figure 3
Figure 3
Adjusted risk of hospital mortality (multivariable analysis) according to the presence of sepsis and/or unchanged brain function (BU), brain function improvement (BI), or brain function deterioration (BD), using non-septic patients without brain dysfunction as reference (REF). Data are expressed as adjusted risk ratios and 95% confidence intervals.
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