Extracranial complications in patients with acute brain injury: a post-hoc analysis of the SOAP study

Objective: To assess the incidence and severity of nonneurological organ dysfunction and its effect on outcome in acute neurological patients in an international cohort observational study. Design and setting: Analysis of database from the observational Sepsis Occurrence in Acutely Ill Patients (SOAP) study in 198 intensive care units (ICUs) in 24 European countries. Patients: All adult patients admitted to the participating ICUs between 1 and 15 May 2002. Of the 3,147 patients in the SOAP database 373 (12%) were admitted with a neurological diagnosis, including 154 (41%) with traumatic brain injury and 186 (50%) with cerebrovascular accident. Measurements and results: Patients were followed until death, hospital discharge, or for 60 days. Neurological patients were younger and had a higher incidence of trauma and fewer comorbidities than nonneurological patients. Neurological patients developed ICU-acquired sepsis and respiratory failure more frequently than the other patients. ICU and hospital mortality rates were higher and ICU length of stay longer in neurological than in nonneurological patients. Multivariate logistic analysis showed that, in addition to the Glasgow Coma Score (GCS) and the presence of nontraumatic brain injury, cardiovascular failure, hepatic failure, and ALI/ARDS were the only factors independently associated with a higher risk of death in the ICU in patients with a neurological diagnosis. Conclusions: Although neurological patients were younger and had fewer comorbidities, they developed ICU-acquired sepsis and respiratory failure more frequently than other patients. Efforts should be oriented to reduce cardiovascular, hepatic, and respiratory complications.