Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo
Non-traumatic coma (NTC) is a common medical condition often associated with poor outcomes. Identifying underlying causes is crucial for effective management and prognostication, particularly in resource-poor settings. This study aimed to identify the most common causes and prognostic factors of NTC...
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| Language: | English |
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Elsevier
2023-08-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023056062 |
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| author | Guy-Quesney Mateso Samuel Makali Ashuza Shamamba Balola Ntaboba Victoire Urbain Musingilwa Eric Emmanuel Murhabazi Martine Mihigo Pacifique Mwene-Batu Landry Kabego Marius Baguma |
| author_facet | Guy-Quesney Mateso Samuel Makali Ashuza Shamamba Balola Ntaboba Victoire Urbain Musingilwa Eric Emmanuel Murhabazi Martine Mihigo Pacifique Mwene-Batu Landry Kabego Marius Baguma |
| author_sort | Guy-Quesney Mateso |
| collection | DOAJ |
| description | Non-traumatic coma (NTC) is a common medical condition often associated with poor outcomes. Identifying underlying causes is crucial for effective management and prognostication, particularly in resource-poor settings. This study aimed to identify the most common causes and prognostic factors of NTC in a tertiary hospital in Bukavu, in the eastern Democratic Republic of the Congo (DRC), using the Glasgow Coma Scale (GCS) as well as other simple and affordable clinical and paraclinical tools. This retrospective observational study included 219 consecutive patients admitted to the intensive care unit of the Provincial General Hospital of Bukavu between January 2016 and December 2018. Sociodemographic, clinical, and laboratory data were also collected. Bivariate and multivariate analyses were performed to identify different causes and factors associated with poor outcomes in these patients. The median age of the patients was 49 (interquartile range [IQR]: 33–61) years, and they were predominantly men (62.8%). The most common causes of NTC were stroke (25.7%), acute metabolic complications of diabetes (21.9%), and primary brain infections (meningoencephalitis, 16.0%; and cerebral malaria, 14.2%). The NTC-related in-hospital mortality rate was 35.2%. A high mortality was significantly and independently associated with a GCS<7 (adjusted odds ratio [OR]: 4.30, 95% confidence interval [CI]: 1.73–10.71), the presence of meningismus at clinical evaluation (adjusted odds ratio [aOR] 3.86, 95%CI: 1.41–10.55), oxygen saturation <90% (aOR 3.99, 95%CI: 1.71–9.28), the consumption of traditional herbal medicines prior to hospital admission (aOR 2.82, 95%CI: 1.16–6.86), and elevated serum creatinine (aOR 1.64, 95%CI: 1.17–2.29). In conclusion, clinical neurological examinations, along with simple and affordable paraclinical investigations, can provide sufficient information to determine the etiology of NTC and evaluate the prognosis of comatose patients, even in resource-poor settings. Physicians may use the GCS as a simple, reliable, and affordable tool to identify patients who require special attention and care. |
| first_indexed | 2024-03-12T12:22:19Z |
| format | Article |
| id | doaj.art-16fd553baf81459bbdc3189ef522fe3c |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-12T12:22:19Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
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| series | Heliyon |
| spelling | doaj.art-16fd553baf81459bbdc3189ef522fe3c2023-08-30T05:51:11ZengElsevierHeliyon2405-84402023-08-0198e18398Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the CongoGuy-Quesney Mateso0Samuel Makali1Ashuza Shamamba2Balola Ntaboba3Victoire Urbain4Musingilwa Eric5Emmanuel Murhabazi6Martine Mihigo7Pacifique Mwene-Batu8Landry Kabego9Marius Baguma10Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo; Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the CongoDepartment of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo; École Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, The Democratic Republic of the CongoUniversité Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the CongoUniversité Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the CongoUniversité Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the CongoUniversité Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the CongoUniversité Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the CongoDepartment of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the CongoDepartment of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo; École Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, The Democratic Republic of the CongoDepartment of Medical Biology, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo; World Health Organization, Regional Office for Africa, Brazzaville, CongoUniversité Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo; Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo; Center for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo; Corresponding author. Université Catholique de Bukavu (UCB), Bukavu, Congo.Non-traumatic coma (NTC) is a common medical condition often associated with poor outcomes. Identifying underlying causes is crucial for effective management and prognostication, particularly in resource-poor settings. This study aimed to identify the most common causes and prognostic factors of NTC in a tertiary hospital in Bukavu, in the eastern Democratic Republic of the Congo (DRC), using the Glasgow Coma Scale (GCS) as well as other simple and affordable clinical and paraclinical tools. This retrospective observational study included 219 consecutive patients admitted to the intensive care unit of the Provincial General Hospital of Bukavu between January 2016 and December 2018. Sociodemographic, clinical, and laboratory data were also collected. Bivariate and multivariate analyses were performed to identify different causes and factors associated with poor outcomes in these patients. The median age of the patients was 49 (interquartile range [IQR]: 33–61) years, and they were predominantly men (62.8%). The most common causes of NTC were stroke (25.7%), acute metabolic complications of diabetes (21.9%), and primary brain infections (meningoencephalitis, 16.0%; and cerebral malaria, 14.2%). The NTC-related in-hospital mortality rate was 35.2%. A high mortality was significantly and independently associated with a GCS<7 (adjusted odds ratio [OR]: 4.30, 95% confidence interval [CI]: 1.73–10.71), the presence of meningismus at clinical evaluation (adjusted odds ratio [aOR] 3.86, 95%CI: 1.41–10.55), oxygen saturation <90% (aOR 3.99, 95%CI: 1.71–9.28), the consumption of traditional herbal medicines prior to hospital admission (aOR 2.82, 95%CI: 1.16–6.86), and elevated serum creatinine (aOR 1.64, 95%CI: 1.17–2.29). In conclusion, clinical neurological examinations, along with simple and affordable paraclinical investigations, can provide sufficient information to determine the etiology of NTC and evaluate the prognosis of comatose patients, even in resource-poor settings. Physicians may use the GCS as a simple, reliable, and affordable tool to identify patients who require special attention and care.http://www.sciencedirect.com/science/article/pii/S2405844023056062ComaEtiologyHospital mortalityPrognosisIntensive care units |
| spellingShingle | Guy-Quesney Mateso Samuel Makali Ashuza Shamamba Balola Ntaboba Victoire Urbain Musingilwa Eric Emmanuel Murhabazi Martine Mihigo Pacifique Mwene-Batu Landry Kabego Marius Baguma Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo Heliyon Coma Etiology Hospital mortality Prognosis Intensive care units |
| title | Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo |
| title_full | Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo |
| title_fullStr | Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo |
| title_full_unstemmed | Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo |
| title_short | Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo |
| title_sort | etiologies and factors associated with mortality in patients with non traumatic coma in a tertiary hospital in bukavu eastern democratic republic of the congo |
| topic | Coma Etiology Hospital mortality Prognosis Intensive care units |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023056062 |
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