Informatics in Medicine Unlocked 29 (2022) 100904

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Informatics in Medicine Unlocked

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The association of Glasgow Coma Scale score with characteristics of

patients admitted to the intensive care unit
Mohammad Fathi a, b, Nader Markazi Moghaddam a, c, *, Sanaz Zargar Balaye Jame c,
Mohammad Darvishi d, Morteza Mortazavi e
a
Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
b
Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
c
Department of Health Management and Economics, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
d
Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic Medicine, Aja University of Medical Sciences, Tehran,
Iran
e
Aja University of Medical Sciences, Tehran, Iran

A R T I C L E I N F O A B S T R A C T

Keywords: We investigated the associations between Glasgow Coma Scale scores and individuals’ characteristics in patients
Glasgow coma scale admitted to the Intensive Care Unit following an emergency surgery compared with other Intensive Care Unit
Prediction model patients. The study began in March 2020 and lasted for one year. It was conducted in the Department of Surgery
Intensive care unit
at a teaching hospital affiliated with a Medical University. We analyzed data from a dataset including 2055
Emergency
Surgery
included patients with a mean (SD) age of 55.0 (15.6) years. Overall, 983 (47.8%) patients were women, and 623
(30.3%) underwent emergency surgery. The outcome variable was the Glasgow Coma Scale score and the pre­
dictors were a large number of patients’ demographic, comorbidity, clinical, and laboratory features. The
emergency surgery model showed a relatively accurate predictive ability [adjusted R2 = 75.1%, F (11, 486) =
136.0, p < 0.001] for estimating Glasgow Coma Scale scores. Respiratory rate, immunosuppressive state, having
a nosocomial infection, the fraction of inspired oxygen, sex, age, blood sugar, and bilirubin concentration were
statistically significant predictors of the Glasgow Coma Scale scores (all p < 0.05). The model for other patients
was less accurate [adjusted R2 = 65.0%, F (7, 1136) = 300.1, p < 0.001], but significant for respiratory rate,
fraction of inspired oxygen, sex, nosocomial infection, and serum creatinine (all p < 0.05). We concluded that
Glasgow Coma Scale scores can be predicted using patients’ characteristics in individuals admitted to the
Intensive Care Unit following emergency surgery. Multi-organ dysfunction in emergency situations leads to
neurological impairment beyond brain physical trauma.

1. Introduction
The Glasgow Coma Scale (GCS) is often used to evaluate the level of
consciousness in acute medical and trauma patients [1–3]. Due to the
widespread use of the scale, GCS remains the standard for communi­
cating among healthcare professionals in assessing impairment of con­
sciousness, guiding management, predicting readmission, and
comparing different groups of patients at risk for mortality [2,4–7]. This
made GCS score to serves as a marker for the severity of medical
condition in patients admitted to the intensive care unit (ICU), as well
[2,3,8]. A recent review study showed that in well-designed studies,
kappa values were ≥0.6 in 85%, and all intra-class correlation co­
efficients were excellent for GCS. Though, poor-quality studies showed
lower reliability for GCS. However, another recent systematic review
showed a greater discrimination for total GCS than the motor compo­
nent of the GCS for in-hospital mortality, receipt of neurosurgical in­
terventions, severe brain injury, and emergency intubation [1,9].
Training of caregivers and the quality of data affect the results of studies

Abbreviations: GCS, Glasgow Coma Scale; ICU, Intensive Care Unit; ES, Emergency Surgery; SD, Standard Deviation; CI, Confidence Interval; FiO2, Fraction of
Inspired Oxygen; ACTH, Adrenocorticotropic Hormone.
* Corresponding author. Department of Health Management and Economics, Faculty of Medicine, Aja University of Medical Sciences, Shahid Etemadzadeh St.,
Western Fatemi, Tehran, Postal code: 1411718541, Iran.
E-mail addresses: m.fathi@sbmu.ac.ir (M. Fathi), nmmoghaddam@sbmu.ac.ir (N.M. Moghaddam), sanazzargar@ajaums.ac.ir (S.Z. Balaye Jame), Darvishi1349@
gmail.com (M. Darvishi), mz.mortazavig@gmail.com (M. Mortazavi).

https://doi.org/10.1016/j.imu.2022.100904
Received 2 November 2021; Received in revised form 5 March 2022; Accepted 5 March 2022
Available online 8 March 2022
2352-9148/© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
M. Fathi et al.
on the reliability of GCS [1,10,11].
The GCS scale was transformed into score, and was proved as being
useful in summarizing patients’ medical condition [2,11]. Research
studies investigated the association of GCS scores with other clinical
outcomes as it can be influenced by many predictors. In these studies,
GCS is frequently considered as the surrogate for dysfunction of the
central nervous system in medical or traumatic patients, and the asso­
ciation of clinical predictors with GCS is believed to imply a prognostic
value for the GCS. Clinicians suggested that GCS is related to age [3,12,
13], traumatic axonal injury [14], or computed tomography-scan find­
ings [15,16]. Also, research studies showed that plasma glucose [17,18],
serum trace elements [19], nitric oxide [20], chitinase-3-like protein 1,
amyloid A1, C-reactive protein, and procalcitonin combined with
S100beta (a small calcium-binding protein) [21], and serum
neuron-specific enolase [22] are correlated with GCS score in different
subgroups of patients. In the studies investigating the association of GCS
scores with other clinical outcomes, the target population were specif­
ically patients with traumatic brain injury. Meanwhile, our literature
review suggested that there is a paucity of information on the associa­
tion of GCS with routine clinical assessments in patients admitted to ICU
following emergency surgery (ES).
We explored patients’ data at the time of admission to the ICU of a
tertiary hospital. The aim of conducting this study was to find if there are
associations between GCS scores and individuals’ characteristics in pa­
tients undergoing ES compared with other patients (Non-ES). A large
number of demographic, clinical, and laboratory findings and several
comorbidities were incorporated into the predictive models. We hy­
pothesized that the GCS score would be significantly predicted by pa­
tients’ attributes within 24 h of ICU admission.
2. Material and methods
2.1. Design and setting
We carried out a cross-sectional study of ICU patients. The study
began in March 2020 and lasted for one year. It was conducted by the
Critical Care Quality Improvement Research Center, affiliated with
Shahid Beheshti University of Medical Sciences. The research was per­
formed in accordance with the Declaration of Helsinki. Ethics approval
was obtained from the Institutional Review Boards of Aja University of
Medical Sciences with the ethics code of IR.AJAUMS.REC.1397.697696.
All participants or their companions signed written consents for using
patients’ data in the analyses. Patients were from two teaching hospitals
affiliated with Aja or Shahid Beheshti University of Medical Sciences.
The hospitals are well-equipped settings with high patient turnovers,
and are large referral and subspecialty centers.
2.2. Data collection
We included all adult patients who were admitted to the ICU. A
number of demographic, clinical, and laboratory features were recorded
for each patient within the first 24 h of admission. Also, patients were
monitored for undergoing any important procedure, and for mortality
during the ICU stay. In each work shift, a study nurse recorded the in­
formation for each patient. Data were entered into a paper form, and
then, into the spreadsheet of Microsoft Office Excel software. The
presence of duplicated or missing data was investigated, and the cor­
rectness of data was confirmed by examining 20% of the data.
2.3. Outcome and predictors variables
The outcome variable of the study was the GCS score. The scores
were determined by four study anesthesiologists and intensivists who
were experts in the assessment of patients. We considered the modified
GCS classes for traumatic brain injuries in which the GCS scores of
13–15, 9–12, and 3–8 correspond to mild, moderate, and severe classes
2
Informatics in Medicine Unlocked 29 (2022) 100904
of modified GCS [23–25]. The predictors were primarily selected based
on a consensus of the authors considering the limits of time, budget, and
personnel [26,27]. We recorded patients’ sex and age, important
comorbidities, vital signs, information on nosocomial infections, arterial
blood gas, and a number of other laboratory test results, and mortality.
Data were assessed for variables’ distribution, and severe class imbal­
ance (less than 1% frequency for any level).
2.4. Feature selection and modeling
Results are presented as mean (SD) for continuous variables, and as
absolute numbers (%) for categorical data. For point estimates, 95%
confidence intervals, and p-values were calculated. P-values less than
0.05 were considered significant. The means of the continuous variables
were compared using independent sample t-tests and the proportions of
the categorical variables were compared with chi-squared test. We used
the random forest to estimate the importance of variables in predicting
GCS. The random forest was used for feature selection because of its
good performance, low overfitting, easy interpretability, and robustness
to the presence of correlated features [28]. For the random forest, we
used the Boruta algorithm with the maximum run of 100 to evaluate
output variable importance. The Boruta performs a top-down search for
relevant features by comparing original attributes’ importance with
importance achievable at random, estimated using their permuted
copies, and progressively eliminating irrelevant features. To calculate
errors, the data were then partitioned into development (training) and
validation (test) datasets including 80% and 20% of the data, respec­
tively. Next, we included the selected variables into two linear regres­
sion models to predict GCS scores using the data of patients who
underwent ES and of patients with Non-ES reasons for admission. The
models were multivariable with GCS as the dependent and patients’
attributes as independent variables:
y = β 0 + β 1 X1 + β 2 X2 + … + β n Xn + ε
where y is the predicted value of GCS, β0 is the y-intercept, βiXi is the
regression coefficient βi of the ith attribute Xi, and ε is model error. All
non-elective surgeries that were performed when the patient’s life were
in danger was considered as ES. Using the Akaike information criterion,
we carried out a stepwise forward modeling process to find the best set
of predictors for developing the two models. The models’ assumptions,
fitness and generalizability were assessed with appropriate diagnostics.
Adjusted R2 was calculated for representing the proportion of the vari­
ance for GCS scores that is explained by predictors. The root mean
square error was computed for ES and Non-ES models. We also calcu­
lated studentized and standardized residuals, Cook’s distance, the
variance inflation factor to assess outliers, influential points, and the
presence of multicollinearity for the two models. The Durbin-Watson
test was used to evaluate the independence of errors.
2.4.1. Software
We imported the data into R software version 4.0.2 (R Foundation for
Statistical Computing, Vienna, Austria. https://www.R-project.org/).
We used a variety of R packages for the analyses. All the packages were
downloaded from the Comprehensive R Archive Network (https://cran.
r-project.org/), the official R package repository, or the GitHub
(https://github.com/) website.
3. Results
3.1. Sample
We had 2055 patients in our sample of ICU patients of which, 865
(42.1%) died. There were no missing data or duplicate cases in our
sample (Table 1). Mean (SD) for GCS scores was 10.7 (2.4) with the 95%
CI of (10.61, 10.82) and the median (interquartile range) was 11.0 (9.0,
M. Fathi et al. Informatics in Medicine Unlocked 29 (2022) 100904

Table 1 13.0). Fig. 1 shows the distribution of GCS scores in the sample. Fig. 2
Characteristics of the study sample. illustrates the results of the feature selection result and Fig. 3 illustrates
Feature All (N = GCS Classes p the heatmap of the features. The features were sorted according to their
2055) importance to the prediction. We included the selected predictors in the
[13–15] [9–12] [3–8] (N
(N = 584) (N = = 356) modeling process.
1115)

Number (%) 3.2. Model development and specification

Died 865 236 487 142 0.281
(42.1) (40.4) (43.7) (39.9) For the ES model, adjusted R2 was 75.1% [F (11, 486) = 136.0, p <
Female 983 291 510 182 0.109
0.001], and for the Non-ES was 65.0% [F (7, 1136) = 300.1, p < 0.001].
(47.8) (49.8) (45.7) (51.1)
Surgical Patient 1134 333 578 223 0.001* The Akaike information criterion for the steps of modeling decreased
(55.2) (57.0) (51.8) (62.6) from 943.15 in the base to 265.03 in the final model for the ES, and from
Emergency 623 143 308 172 <0.001* 1924.27 to 740.56 for the Non-ES model. Using the test data, the root
Surgery (30.3) (24.5) (27.6) (48.3) mean square error for ES and Non-ES were 1.34 and 1.32, respectively.
Diabetes 631 187 329 115 0.437
(30.7) (32.0) (29.5) (32.3)
Table 2 shows the specifications of the two models. For ES patients a
Immune 295 72 (12.3) 140 83 (23.3) <0.001* variety of demographic and comorbidities, clinical, and laboratory fea­
Suppression (14.4) (12.6) tures were significant in predicting GCS scores. Both models showed
Myocardial 391 118 202 71 (19.9) 0.517 significant relations between GCS and respiratory rate, immunosup­
Infarction (19.0) (20.2) (18.1)
pressive state, nosocomial infection, FiO2, and the male sex. In the ES
COPD 282 78 (13.4) 162 42 (11.8) 0.408
(13.7) (14.5) model, the coefficient of WBC count; and in the Non-ES model, the co­
Chronic Kidney 141 (6.9) 25 (4.3) 86 (7.7) 30 (8.4) 0.013* efficient of urine volume was too small to affect the results.
Disease The standardized residuals analyses showed that both models had
Nosocomial Pathogen five outliers (Fig. 4). Also, there were no cases with the Cook’s distance
None 1748 524 939 285
of more than 1 in the two models. For the ES model, the average variance
<0.001*
(85.1) (89.7) (84.2) (80.1)
Klebsiella 75 (3.6) 11 (1.9) 42 (3.8) 22 (6.2) 0.003* inflation factor was 1.51 with the maximum of 2.99, and the minimum
Pseudomonas 17 (0.8) 5 (0.9) 8 (0.7) 4 (1.1) 0.759 tolerance of 0.33 (for respiratory rate); and for Non-ES, they were 1.83,
Staph. Aureus 64 (3.1) 12 (2.1) 36 (3.2) 16 (4.5) 0.107 3.09, and 0.32 (for respiratory rate), respectively. Overall, there were no
Acinetobacter 74 (3.6) 20 (3.4) 38 (3.4) 16 (4.5) 0.609
serious problems concerning influential points and multicollinearity for
E.coli 71 (3.5) 12 (2.1) 46 (4.1) 13 (3.7) 0.083
Candida 6 (0.3) 0 (0.0) 6 (0.5) 0 (0.0) 0.079 the two models. The Durbin-Watson test did not find significant auto­
Mean (SD) correlation for ES [autocorrelation = 0.007, D-W = 1.972, p = 0.670],
Age (year) 55.0 54.1 55.7 54.3 0.145 but indicated a violation of independent error assumption for Non-ES
(15.6) (13.2) (15.9) (18.0) model [autocorrelation = 0.072, D-W = 1.854, p = 0.020]. However,
Temperature (◦ C) 37.8 37.8 (0.4) 37.8 37.8 0.999
because the p value for the Durbin-Watson test was approaching sig­
(0.4) (0.4) (0.4)
Systolic Blood 108.7 109.5 108.3 108.8 0.502 nificance for the Non-ES model (0.072) while other diagnostic tests re­
Pressure (20.1) (20.2) (20.0) (20.0) sults were favorable, we did not change the structure of the model.
(mmHg) Table 3 shows the comparison of ES with Non-ES groups.
Pulse Rate (n/ 87.5 87.5 87.6 86.9 0.626
min) (12.0) (11.7) (12.2) (11.7)
Respiratory Rate 24.0 19.2 (1.6) 24.6 30.1 <0.001* 4. Discussion
(n/min) (5.7) (5.8) (2.0)
Diastolic Blood 7.4 (0.1) 7.4 (0.1) 7.4 (0.1) 7.4 (0.1) 0.999 We assessed a large number of patients’ characteristics for predicting
pH GCS scores in patients who underwent ES and in the remaining patients
FiO2 (%) 46.9 31.9 (5.9) 48.5 66.2
admitted to ICU for reasons other than ES. Our study showed that there
<0.001*
(20.2) (20.6) (15.2)
PaO2 (mmHg) 69.2 68.3 69.4 70.1 0.461 were significant relations between GCS and demographic characteris­
(22.8) (22.2) (23.0) (23.2) tics, comorbidities, clinical, and laboratory features in the ES group. The
PaCo2 (mmHg) 39.9 39.4 40.1 39.8 0.485 resulted ES model showed a relatively accurate predictive ability for
(11.4) (11.1) (11.7) (11.1)
estimating GCS scores. The accuracy was less prominent in the Non-ES
Serum Na 134.4 134.6 134.3 134.1 0.009*
(mmol/L) (2.6) (2.4) (2.6) (2.7) model. This might be owing to the non-homogenous subgroups of pa­
Blood Sugar 144.4 143.6 144.6 145.0 0.904 tients in the Non-ES patients. In the ES group, respiratory rate,
(mmol/L) (52.0) (50.9) (51.7) (54.9)
Serum Creatinine 1.2 (0.4) 1.2 (0.3) 1.2 (0.4) 1.2 (0.4) 0.999
(mg/dL)
Blood Urea 40.0 39.2 40.2 40.6 0.248
Nitrogen (mg/ (14.0) (11.8) (14.4) (15.9)
dL)
Urine Volume 2289.0 2368.5 2250.7 2278.7 0.002*
(mL) (657.6) (611.3) (661.0) (708.9)
Serum Albumin 3.3 (0.5) 3.3 (0.5) 3.3 (0.5) 3.3 (0.6) 0.999
(g/dL)
Hematocrit (%) 35.5 35.5 (4.9) 35.5 35.5 0.999
(4.8) (4.7) (4.5)
WBC (n/μL) 8897.5 8898.3 8748.9 9361.5 0.006*
(3148.1) (3016.4) (3106.8) (3438.7)

COPD: Chronic Obstructive Pulmonary Disease; FiO2: Fraction of Inspired Ox­

ygen; PaO2: Partial Pressure of Oxygen; PaCO2: Partial pressure of carbon di­
oxide; BUN: Blood Urea Nitrogen.

Fig. 1. Histogram of GCS scores in the sample.

3
M. Fathi et al.
Fig. 2. Variable importance for predicting the GCS scores. The white boxplots illustrate the selected features. PaO2: Partial Pressure of Oxygen; PaCO2: Partial
pressure of carbon dioxide; SBP: Systolic Blood Pressure; COPD: Chronic Obstructive Pulmonary Disease; MI: Myocardial Infarction; Hct: Hematocrit; CKD: Chronic
Kidney Disease; BUN: Blood Urea Nitrogen; FiO2: Fraction of Inspired Oxygen.
Fig. 3. Feature heatmap showing correlations between the features.
immunosuppressive state, nosocomial infection, FiO2, the male sex, age,
blood sugar, and bilirubin concentration were statistically significant
predictors of GCS. It is believed that traumatic damages to subcortical
white matter dissociate metabolism between the cerebral cortex and
deeper brain regions [18]. Meanwhile, our results might be an impli­
cation for the presence of multi-organ dysfunction in emergency situa­
tions and for the role of internal environment instability in neurological
impairment beyond physical trauma. In the Non-ES patients, respiratory
4
Informatics in Medicine Unlocked 29 (2022) 100904
rate, FiO2, the male sex, nosocomial infection, and serum creatinine
concentration were statistically significant.
Research studies controversially suggested that GCS could be used as
a guide to decision-making for the treatment of patients with critical
conditions [29,30]. Also, GCS is thought to convey prognostic infor­
mation for the outcome of treatment in ICU patients [6,13,31,32]. In
addition to defining a combination of GCS with other indices of criti­
cality, researchers tried to increase the accuracy of GCS prognostic
ability by subgrouping patients into clinically meaningful classes [33].
We had categorized our patients to ES versus Non-ES rather than using
traditional classes of brain trauma versus non-brain trauma. The results
should have been reasonably affected by the way we categorized our
patients. However, this grouping of patients allowed us to cover a larger
spectrum of patients.
Our results comply with some data scattered in the literature con­
cerning brain trauma patients [34–38]. Respiratory rate on arrival at the
emergency department has been shown to be an explanatory variable for
in-hospital mortality of trauma patients [39]. A previous study on
trauma patients had shown that on arrival, patients experience an
elevated ACTH and cortisol concentration which declines to normal
value over five days [34]. An immunosuppressive state alters the normal
pattern of healing and increases the risk for poor outcomes. Similar to
our results, nosocomial infections have been reported to be associated
with low GCS in traumatic brain injury [35]. A study suggested that
FiO2 was inversely correlated with cerebral blood flow after severe head
injury leading to poor brain tissue oxygen delivery and lactate accu­
mulation [36]. Our study replicated the findings regarding the inverse
relation between GCS and bilirubin [37], and the results concerning age,
and sex [38].
In a correlational study, Bae et al. investigated the relation between
serum factors at admission and the outcome of traumatic brain injury. A
combination of serum factors and the GCS was proposed as a prognostic
model for the patient undergoing decompressive craniectomy. They
included 219 patients (44 women) with a mean (SD) age of 49 (11.5)
M. Fathi et al. Informatics in Medicine Unlocked 29 (2022) 100904

Table 2
Characteristics of the two linear models.
ES Non-ES

Feature B SE p Feature B SE p
(Intercept) 19.602 0.572 <0.001* (Intercept) 16.982 0.352 <0.001*
Respiratory Rate (n/min) − 0.259 0.017 <0.001* Respiratory Rate (n/min) − 0.262 0.013 <0.001*
Immune Suppression − 3.197 0.322 <0.001* FiO2 (%) − 0.020 0.004 <0.001*
Nosocomial Infection − 1.557 0.364 <0.001* Sex (male) 0.373 0.083 <0.001*
FiO2 (%) − 0.022 0.004 <0.001* Nosocomial Infection − 0.505 0.104 <0.001*
Sex (male) − 0.354 0.128 0.006* Creatinine (mg/dL) 0.577 0.126 <0.001*
WBC (n/μL) 0.000 0.000 0.002* Urine Volume (mL) 0.000 0.000 0.042*
Hct (%) − 0.031 0.013 0.022* Immune Suppression − 0.163 0.107 0.127
Age (year) 0.016 0.005 0.001*
Blood Sugar (mmol/L) − 0.003 0.002 0.030*
Bilirubin (μmol/L) − 0.132 0.068 0.045*
CKD 1.144 0.715 0.110

ES: patients who underwent emergency surgery; SE: Standard Error; FiO2: Fraction of Inspired Oxygen; MI: Myocardial Infarction; Hct: Hematocrit; CKD: Chronic
Kidney Disease.
*Significant at p < 0.05.

Fig. 4. Residuals of the ES (left column) and Non-ES (right column) models. The dashed lines represent reference values. ES: patients who underwent emer­
gency surgery.

years. Hemoglobin, platelets, prothrombin time, and lactate dehydro­
genase were dichotomized and incorporated into a logistic model. They
suggested that the combination is of prognostic value [24]. Overall, GCS
is a well-established means of neurological assessment in critically ill
patients. We included a larger sample; assessed a larger number of
features; and found the relations between GCS scores and patients’
characteristics. Indeed, our study implied that the construct of GCS re­
lies upon some pathophysiological processes. From the statistical point
of view and owing to the collinearities, those predictors are not rec­
ommended to be combined with GCS in predicting an outcome.
Kotera et al. investigated the association between the GCS score and
plasma glucose concentration. In a retrospective cohort study, they
included 41 hypoglycemic patients into mild (n = 14) and moderate/
severe (n = 27) hypoglycemia groups. The relation between the GCS
score and plasma glucose was evaluated with Spearman rank correla­
tion. The GCS scores of the mild hypoglycemia group were significantly
higher than the other group (p = 0.0367). They concluded that the
correlation of the GCS score and plasma glucose differed according to
the severity of hypoglycemia. They recommended the assessment of
blood glucose even in patients with high GCS scores [17]. Hattori et al.
included 11 healthy people and 23 patients with traumatic brain injury
who underwent positron emission tomography with fluorodeoxyglucose
integrated with computed tomography within 5 days after injury. They
suggested that there is a significant difference in glucose metabolism in
the thalamus, brain stem, and cerebellum between comatose and
non-comatose patients shortly after the injury. The metabolic rate of
glucose correlated with the level of consciousness [18]. Also, the
changes of serum trace elements following trauma have been suggested
to be associated with multiple organ failure and their monitoring has
been recommended in severe traumatic patients [19]. Our study showed
the possibility of metabolic changes and multiple organ dysfunction
among patients undergoing ES, as well.

5
M. Fathi et al. Informatics in Medicine Unlocked 29 (2022) 100904

Table 3 and coordinated the research process. MM participated in designing the

Comparison of ES with Non-ES groups. study, coordinated data record and performed statistical analyses. All
Feature Group p the authors participated in drafting and its final approval.
ES (N = 623) Non-ES (N = 1432)
Funding support
Respiratory Rate (n/min) 25.2 (5.7) 23.5 (5.6) <0.001*
Immune Suppression 31 (5.0%) 264 (18.4%) <0.001*
Nosocomial Infection 19 (3.0%) 288 (20.1%) <0.001* This research did not receive any specific grant from funding
FiO2 (%) 51.1 (21.1) 45.1 (19.6) <0.001* agencies in the public, commercial, or not-for-profit sectors.
Sex (male) 330 (53.0) 742 (51.8) 0.665
WBC (n/μL) 8569.5 (2717.9) 9040.2 (3308.6)
Declaration of competing interest
<0.001*
Hct (%) 35.4 (4.7) 35.6 (4.8) 0.359
Age (year) 46.3 (13.7) 58.8 (14.9) <0.001*
Blood Sugar (mmol/L) 133.1 (39.9) 149.3 (55.8) <0.001* The authors declare that they have no known competing financial
Bilirubin (μmol/L) 1.9 (1.1) 1.8 (1.4) 0.311 interests or personal relationships that could have appeared to influence
CKD 7 (1.1%) 134 (9.4%) <0.001*
the work reported in this paper.
Creatinine (mg/dL) 1.1 (0.2) 1.3 (0.4) <0.001*
Urine Volume (mL) 2362.9 (545.7) 2256.8 (698.5) <0.001*
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