Abstract:
The clinical epidemiology of adults admitted with reduced level of consciousness (LOC) in Sub- Saharan Africa (SSA), and the impact of HIV infection on the risk of mortality in this population is not known. We secondarily analyzed data from 336 individuals with reduced LOC and known HIV status, obtaining clinical, laboratory, and 30-day follow-up data. We recorded the investigations and treatments deemed critical by clinicians for patient care but were unavailable (unmet clinical need). We summarized patient characteristics, computed mortality rates, and used logistic regression to determine predictors of 30-day mortality. The mean age was 51 years. Reduced LOC was mostly associated with metabolic encephalopathy 106/336 (32%), CNS infections 93/336 (28%), and stroke 73/336 (22%). The median admission Glasgow Coma Scale was 10. Persons Living with HIV infection (PLWH) accounted for 97/336 (29%) of the cohort. Compared to HIV negative individuals, PLWH were younger and more likely to present with diarrhea, vomiting, headache, cough, anemia, and leukopenia. The thirty-day mortality rate in the total cohort was 159/359 (45%), and this was significantly higher in PLWH (57% vs 40%, adjusted OR [95% CI] 2.48 [1.35, 4.55], p=0.0033). Predictors of mortality on multivariable regression analysis were presence of any unmet clinical need, serum potassium, HIV infection, and an admission FOUR Score <12. Presentation with reduced LOC in Uganda is associated with high mortality rates, with worse outcomes in PLWH. Expansion of existing acute care services and other required diagnostic studies may lead to better outcomes in this population.