Abstract
Background
Patients intubated due to AMS in resource-limited settings experience alarmingly high mortality rates. This unique under-researched cohort requires further study for tailored care and resource allocation. This study aimed to investigate the outcomes and predictors of mortality among intubated patients with altered mental status.
Methods
This prospective observational cohort enrolled patients intubated due to a GCS score of less than 8. The patients were followed till the mortality or discharge, and various demographic and clinic-biochemical parameters were recorded. The primary outcome was mortality, and its predictors were studied.
Results
The mean (SD) age was 43 (17) years, 55% being females. The median (IQR) CCI score was 1 (0,1), with diabetes mellitus being the most common (31.8%). The most common cause of AMS was meningoencephalitis (34%), followed by septic encephalopathy (17%). Median GCS at intubation was 6 (4, 8). The median duration of mechanical ventilation was longer in non-survivors (7, 3–15 days). The median length of hospital stay was 11(5,21.5) days, longer in survivors. The overall mortality was 65%. CRP, LDH, and place of intubation were independent predictors of mortality. Both SOFA and APACHE on the day of intubation underpredicted mortality. The hospital-acquired infection rate was high (47%). The median mRS at discharge was 4 (2, 5).
Conclusion
Patients intubated for altered mental status represent a distinct group, facing prolonged ventilation, heightened infection risk, and substantial mortality, challenging conventional prognostic models; post-discharge, they exhibit compromised function, necessitating intensive home care and stringent infection control measures.