Causes of coma and their evolution in the medical intensive care unit

Weiss, Nicolas; Regard, Lucile; Vidal, Charles; Luque, Yosu; Taldir, Guillaume; Vallet, Hélène; Diehl, Jean‐Luc; Fagon, Jean-Yves; Guérot, Emmanuel

doi:10.1007/s00415-011-6388-z

Cited by 33 publications

(23 citation statements)

References 8 publications

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“…Patients with stroke had the highest mortality (60-95%), followed by patients with post-anoxic coma (54-89%) (Table 3 ). In contrast, the lowest mortality was found for poisoning and epilepsy: 0-7% and 0-10%, respectively and 35-67% for poisoning in the African studies [ 8 , 10 - 13 , 16 , 18 ].…”

Section: Resultsmentioning

confidence: 89%

“…Reported prevalence of structural coma varied between 28-64% and non-structural coma between 37-75% of patients presenting with non-traumatic coma [ 6 , 9 , 11 , 14 - 17 ]. Of note, Weiss et al only reported a structural coma prevalence of 9% (cerebrovascular accidents and infections of the central nervous system) [ 18 ]. It should however be noted that as this hospital does not have a neurological or neurosurgical ward, this is likely to influence the incidence of reported coma.…”

Section: Resultsmentioning

confidence: 99%

“…We tried to include observational cohorts who used similar inclusion criteria for patients with NTC, being a GCS <10 and were able to include over 5,000 patients in our systematic review. Of note, Weiss et al included an important number of patients in their report (N = 2189), which was by far the largest study included in this review [ 18 ]. Despite its size, our study has major drawbacks as we found a large variability in the different cohorts and outcomes.…”

Section: Discussionmentioning

confidence: 99%

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The etiology and outcome of non-traumatic coma in critical care: a systematic review

et al. 2015

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BackgroundNon-traumatic coma (NTC) is a serious condition requiring swift medical or surgical decision making upon arrival at the emergency department. Knowledge of the most frequent etiologies of NTC and associated mortality might improve the management of these patients. Here, we present the results of a systematic literature search on the etiologies and prognosis of NTC.MethodsTwo reviewers independently performed a systematic literature search in the Pubmed, Embase and Cochrane databases with subsequent reference and citation checking. Inclusion criteria were retrospective or prospective observational studies on NTC, which reported on etiologies and prognostic information of patients admitted to the emergency department or intensive care unit.ResultsEventually, 14 studies with enough data on NTC, were selected for this systematic literature review. The most common causes of NTC were stroke (6-54%), post-anoxic coma (3-42%), poisoning (<1-39%) and metabolic causes (1-29%). NTC was also often caused by infections, especially in African studies affecting 10-51% of patients. The NTC mortality rate ranged from 25 to 87% and the mortality rate continued to increase long after the event had occurred. Also, 5-25% of patients remained moderately-severely disabled or in permanent vegetative state. The mortality was highest for stroke (60-95%) and post-anoxic coma (54-89%) and lowest for poisoning (0-39%) and epilepsy (0-10%).ConclusionNTC represents a challenge to the emergency and the critical care physicians with an important mortality and moderate-severe disability rate. Even though, included studies were very heterogeneous, the most common causes of NTC are stroke, post anoxic, poisoning and various metabolic etiologies. The best outcome is achieved for patients with poisoning and epilepsy, while the worst outcome was seen in patients with stroke and post-anoxic coma. Adequate knowledge of the most common causes of NTC and prioritizing the causes by mortality ensures a swift and adequate work-up in diagnosis of NTC and may improve outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0041-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The etiology and outcome of non-traumatic coma in critical care: a systematic review

et al. 2015

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“…14 Non-traumatic unconscious patients presenting with a stroke have the highest mortality, while those presenting with epilepsy and poisoning have the best prognosis. 14,16,17 A Swedish study of coma patients presenting to the Emergency Department found initial inpatient mortality to be 27%, rising to 39% at 1 year. 18 Patients with a lower GCS at presentation, 3-5, have a significantly higher mortality than those with a GCS of 7-10.…”

Section: Prognosismentioning

confidence: 99%

A systematic approach to the unconscious patient

Cooksley¹,

Rose

Holland

2018

Clinical Medicine

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“…Hyperammonemia can be responsible for acute brain oedema and death but also for irreversible neurological dysfunction. 29 Likewise, fatal outcomes have occurred in adults who received therapy more than one day after the onset of coma. 30 Thus, in complement to symptomatic treatment of brain oedema, decreasing ammonia levels is a top priority when neurological symptoms are present in OTC deficiency.…”

Section: Should Lt Be Proposed?mentioning

confidence: 99%

Peak hyperammonemia and atypical acute liver failure: The eruption of an urea cycle disorder during hyperemesis gravidarum

Weiss

Mochel

Rudler

et al. 2018

Journal of Hepatology

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Inborn urea cycle disorders are under-recognised metabolic causes of hyperammonemia in adults. A 28-year-old primigravida, seven weeks pregnant, affected by hyperemesis gravidarum developed acute liver injury (ALI) and then acute liver failure (ALF) in less than 48 h. Because the patient developed atypical features, especially mildly elevated aminotransferases contrasting with very high blood ammonia levels (281 μmol/L), concomitant with normal serum creatinine, an inborn error of metabolism was suspected. We performed emergency metabolic analyses, stopped all protein intake and started with intravenous (i.v.) high caloric intake, nitrogen scavenger drugs and haemodialysis. The neurological and hepatic status of the patient quickly improved together with normalisation of her ammonemia levels. High plasma glutamine and urinary orotic acid, alongside low plasma arginine, citrulline and ornithine were suggestive of an ornithine transcarbamylase deficiency, later confirmed by molecular analyses. Foetal sex was female, as determined by foetal DNA analysis in maternal blood, and foetal development was unremarkable throughout the pregnancy. Delivery was induced at 39 weeks with a close monitoring of ammonemia levels and i.v. perfusion of carbohydrates and lipids during labour and immediately post-partum to avoid hypercatabolism. Delivery was uneventful and the patient delivered a healthy female baby. Urea cycle disorders should be contemplated in non-jaundiced patients with ALI or ALF, severe hyperammonemia and normal serum creatinine regardless of serum aminotransferase levels. The prompt recognition of this rare condition and the rapid initiation of adequate metabolic therapy are mandatory to prevent irreversible neurological sequelae and to avoid liver transplantation.

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Causes of coma and their evolution in the medical intensive care unit

Cited by 33 publications

References 8 publications

The etiology and outcome of non-traumatic coma in critical care: a systematic review

The etiology and outcome of non-traumatic coma in critical care: a systematic review

A systematic approach to the unconscious patient

Peak hyperammonemia and atypical acute liver failure: The eruption of an urea cycle disorder during hyperemesis gravidarum

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