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ORIGINAL ARTICLE   Free accessfree

European Journal of Physical and Rehabilitation Medicine 2021 February;57(1):69-77

DOI: 10.23736/S1973-9087.20.05939-0


language: English

Influence of systemic infection and comorbidities on rehabilitation outcomes in severe acquired brain injury

Gianluca BELLAVITI 1 , Francesca BALSAMO 2, 3, Marco IOSA 4, Danila VELLA 5, Caterina PISTARINI 6

1 Neurorehabilitation Division, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy; 2 Neurorehabilitation Division, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Novara, Italy; 3 Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; 4 Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy; 5 Laboratory of Informatics and Systems Engineering for Clinical Research, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy; 6 Head of Severe Brain Injury Rehabilitation Unit, ICS Maugeri SPA SB, Institute of Nervi, IRCCS, Genoa, Italy

BACKGROUND: Severe infectious complications are a frequent problem in patients with disability due to a severe acquired brain injury. Previous studies reported that the rehabilitation outcome is significantly lower in patients colonized or infected. However, these results could be influenced by comorbidities of those patients admitted in rehabilitation hospital with a lower functional status.
AIM: To explore the influence of systemic infection, in particular concerning multidrug resistant bacteria and analyze the role of comorbidities, as a risk factor for the development of systemic infection, on rehabilitation outcomes in patients with severe brain injury.
DESIGN: This research is a cohort, prospective-observational study, comparing patients with and without systemic infections, in terms of rehabilitation outcomes.
SETTING: An Italian Intensive Care Rehabilitation Department.
POPULATION: A group of 221 patients (mean age: 59 years, range: 16-93 years, 127 males, 94 females) with severe acquired brain injury admitted to rehabilitation hospital.
METHODS: We compared the rehabilitation outcomes between patients with and without a systemic infection (at least a positive blood culture) during the rehabilitation period. A secondary analysis was performed on 70 patients with infection versus 70 patients without infection, matched for functional status at admission. The used clinical scores were: Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Coma Recovery Scale Revised (CRS-R), Glasgow Coma Scale (GCS), Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS), Levels of Cognitive Functioning (LCF) administered at admission and discharge. Length of hospitalization and the role of comorbidities were also considered.
RESULTS: The group of patients with systemic infection (in particular due to Gram-negative bacteria) had a significantly lower outcome for 5 out 6 clinical scales and with a more than doubled length of hospitalization (P<0.001). However, these patients with, at least, a positive blood culture resulted having lower functional status at admission. In the secondary analysis, worst outcome was found in patients with positive blood culture in terms of FIM (P=0.033), GOS (P=0.048), and CRS-R (P=0.001).
CONCLUSIONS: Systemic infections during rehabilitation increased the length of hospitalization and reduce the rehabilitative outcomes, even when the analysis was performed on groups matched for the functional status at admission. Moreover, the cardiological and endocrine metabolic comorbidities seem to influence the outcome, without representing a further risk factor for systemic infection.
CLINICAL REHABILITATION IMPACT: The impact of infections during rehabilitation inpatient should be more taken into account, with specific procedures and suitable environments to avoid the diffusions of infections.

KEY WORDS: Treatment outcome; Bacteremia; Comorbidity; Brain injuries

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