Associations between Glasgow Coma Scale trajectories and 28-day survival rate in patients with sepsis-associated encephalopathy: insights from longitudinal group trajectory modeling

Abstract

Background: Sepsis-associated encephalopathy (SAE) is a common and serious complication of sepsis, characterized by altered consciousness and cognitive dysfunction. This study aimed to investigate the relationship between dynamic changes in Glasgow Coma Scale (GCS) scores during the 5 days prior to ICU admission and 28-day survive rate in patients with SAE. Patients and methods: A retrospective cohort study was conducted using data extracted from the MIMIC-IV v2.0 database. Patients diagnosed with SAE and having daily GCS measurements for 5 days prior to ICU admission were included. A total of 76,943 intensive care unit (ICU) admissions were screened, and 1,389 patients were finally analyzed. Group-based trajectory modeling (GBTM) was employed to categorize patients based on their GCS trajectories, and survival analysis was conducted using Kaplan–Meier curves and Cox regression models. Results: Four distinct GCS trajectory classes were identified: Class 1 (rapid increase), Class 2 (slow increase), Class 3 (rapid decrease), and Class 4 (persistent high level). Patients in Class 4, who had persistent high GCS scores, exhibited the highest survival rate of 82.4 ± 1.2%. In contrast, Class 1, the rapid increase group, had a survival rate of 74.1 ± 3.2%. Both Class 2 (slow increase) and Class 3 (rapid decrease) groups had lower survival rates, with Class 2 at 65.7 ± 5.7% and Class 3 at 65.2 ± 3.6% (p < 0.001). Multivariate Cox regression analysis revealed that patients in classes 1, class 2, and class3 had significantly increased mortality risk compared to Class 4 (p < 0.05). Subgroup analyses indicated that the effect of GCS trajectory on 28-day survive rate was consistent across different subgroups of patients. The ICU stay duration among the four groups of patients showed no statistical difference (p = 0.291). Conclusion: The dynamic changes in GCS scores over the 5 days prior to ICU admission was significantly associated with 28-day survive rate in patients with septic encephalopathy. Monitoring GCS fluctuations can provide valuable prognostic information in this population.