Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo
Guy-Quesney Mateso,
Samuel Makali,
Ashuza Shamamba,
Balola Ntaboba,
Victoire Urbain,
Musingilwa Eric,
Emmanuel Murhabazi,
Martine Mihigo,
Pacifique Mwene-Batu,
Landry Kabego,
Marius Baguma
Affiliations
Guy-Quesney Mateso
Université 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
Samuel Makali
Department 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 Congo
Ashuza Shamamba
Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
Balola Ntaboba
Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
Victoire Urbain
Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
Musingilwa Eric
Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
Emmanuel Murhabazi
Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
Martine Mihigo
Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo
Pacifique Mwene-Batu
Department 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 Congo
Landry Kabego
Department 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, Congo
Marius Baguma
Université 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.
