TIÊN LƯỢNG TỬ VONG VÀ KẾT CỤC CHỨC NĂNG THẦN KINH Ở BỆNH NHÂN HÔN MÊ BẰNG THANG ĐIỂM INCNS

Abstract

Introduction: Coma is a common emergency condition and has many causes with  mortality rate of 20-50%. However, coma is not a permanent condition, many cases of coma recover quite well, so coma requires long-term care and treatment as well as prognosis for appropriate treatment. The INCNS score is built based on 5 components: inflammatory response, nutrition, consciousness, neurological function and systemic condition with 19 factors, maximum total score is 44. The INCNS score may be good at predicting outcome for comatose patients by overcoming the disadvantages of previous scales, including examination of brainstem reflexes and assessment of systemic status. The INCNS score was studied in China; however, not much research has been published yet. The ability to apply the INCNS scale in Vietnam is the reason for us to conduct this study. Objective: To investigate the value of the INCNS scale in predicting mortality and functional neurological outcome in coma patients. Subjects: Patients with coma/change of consciousness not due to trauma admitted to the Emergency Department and Intensive Care Department, Cho Ray Hospital from November 2022 to August 2023. Study design: Prospective cohort study. Results: This study recorded 78 coma patients with an average age of 56.10 ± 16.91 years. The in-hospital mortality rate in the study was 34.62%. Meanwhile, the 30-day mortality rate in the study was 42.31%. The rates of poor functional outcome (mRS ≥ 3) at discharge and 30 days were 92.31% and 64.1%, respectively. The value of the INCNS score in predicting in-hospital mortality and 30-day mortality is 0.698 (95% CI 0.569 - 0.829) and 0.648 (95% CI 0.523 - 0.774), respectively. The value of the INCNS score in predicting 30-day functional neurological outcome is 0.660 (95% CI 0.538 - 0.781). The cut-off point for all three criteria for predicting in-hospital mortality, 30-day mortality and poor functional outcomes according to mRS subgroup is 18.5 with sensitivity of 59.26%, 52,94%, 46%, respectively and the corresponding specificity is 76.47%, 77.27%, 82.1%. Conclusion: The INCNS score has good prognostic value for in-hospital mortality, 30-day mortality and 30-day neurological outcome. There is an improvement in neurological function in comatose patients over time, so a good assessment and prognosis are needed to have an appropriate approach strategy.