Intensive Care Outcomes and Differences Between Survivors and Deceased Patients in a Terminal Coma: A Retrospective Observational Study

Background. Early prognosis for the outcome of a coma-induced critical condition is central to selecting an optimal tactic for patient management. This question remains insufficiently studied, thus justifying the task of identifying significant criteria for differences in terminal coma patients (stage III, irreversible) who died and those recovered to different levels of consciousness.

Objectives. To analyze the intensive care outcomes for patients in a terminal coma and to establish differences between the initial state of patients who have died and those who have recovered to different levels of consciousness.

Methods. A retrospective observational study was conducted on 210 patients aged 21 to 65 hospitalized in the Anesthesiology and Resuscitation Unit of Ochapovsky Regional Clinical Hospital No. 1 (Krasnodarsky Krai) with a diagnosis of terminal coma in the period from 2010 to 2015. The study did not include patients with pregnancy, histologically-confirmed malignancies, cardiovascular diseases (NYHA classes III-IV, according to the New York Heart Association Functional Classification), terminal liver cirrhosis and chronic kidney disease at the stage of hemodialysis. Depending on the critical condition outcome, the admitted patients were divided into groups: group 1 (n = 101) — patients with adverse outcomes; group 2 (n = 109) — patients with relatively favorable outcomes (recovery to a level of consciousness at score 4 and higher, according to The Glasgow Coma Scale). The condition was assessed with referring to available clinical data. Statistical processing of the obtained study results was carried out via nonparametric techniques using Microsoft Excel 10 (Microsoft, USA) and Statistica 6.0 (StatSoft, USA).

Results. The mortality structure against the background of a terminal coma in the following diagnosis: polytrauma — 54%, hemorrhagic stroke — 56%, isolated traumatic brain injury — 37%, acute cerebrovascular accidents (ischemic type) — 33% and acute posthypoxic dyscirculatory encephalopathy — 11%. Intergroup differences between the deceased and survivors were obtained in the following parameters: age (older with unfavorable outcome); base deficit — by 52%; glucose — by 47.6%; troponin — by 47.1%; potassium — by 13.7% and daily diuresis — by 27.5%.

Conclusion. The obtained results are likely to be used in a combination of clinical, instrumental and laboratory examinations in order to provide early detection of the risk group with an adverse outcome.