We sought to elucidate the clinical characteristics, mortality and predictors of mortality among patients admitted with reduced level of consciousness to a tertiary hospital in Uganda.

The mean age (SD) in the cohort was 50.8 (21.7) years and 97/336(28.8%) were HIV positive (HIV+). The median (IQR) Full Outline of Unresponsiveness (FOUR) score was 14 (11 -15). The most common diseases associated with reduced LOC were metabolic encephalopathy 106/336 (31.5%) and central nervous system infections 93/336 (27.7%). An unmet need in clinical care such as lack of respiratory support, electroencephalography, or a crucial medication occurred in 150/336 (44.6%).  In-hospital complications such as respiratory failure, status epilepticus or worsening LOC occurred in 147/289 (50.9%) of individuals. Thirty-day mortality in the total cohort was 148/329 (45.0%) and this was significantly higher among HIV+ individuals compared to HIV-; 55/97(56.7%) vs. 93/233 (39.9%), p=0.005. Predictors of mortality (aOR (95%CI), p value) included admission FOUR score <12 (3.95 (2.21, 7.04), <.0001), anemia (1.70 (1.02, 2.83), 0.0424), respiratory distress (1.68 (1.00, 2.77), p =0.0490), HIV infection (1.93 (1.11, 3.36), p=0.0198) and presence of an unmet clinical need (1.66 (1.01, 2.73), p=0.0468).  

Reduced LOC in Uganda is associated with high mortality rates, with worse outcomes in HIV infected individuals. Provision of intensive care services and other diagnostic studies may mitigate the poor outcomes observed in this population.