Objective:

To develop and validate a prediction model for 90-day mortality in comatose sepsis patients, with a focus on how cerebrovascular disease and dementia modulate the prognostic value of the Glasgow Coma Scale (GCS).

Approach:

• External Validation: Conducted external validation with contemporary institutional data (n = 251) from 2022 to 2026.

Key Findings:

• GCS was not a significant independent predictor in the final model (OR 1.09 per one-point decrease, P = 0.126), but exploratory analyses indicated that lower GCS was associated with higher mortality in patients without cerebrovascular disease (OR 1.45) or dementia (OR 1.40).

Interpretation:

Cerebrovascular disease and dementia significantly modulate the prognostic value of GCS in predicting 90-day mortality in comatose sepsis patients.

Limitations:

• The study is retrospective and may be subject to biases inherent in observational data, including selection bias and confounding factors.
• External validation was limited to one institution, which may affect generalizability.

Conclusion:

The developed model provides superior risk stratification for comatose sepsis patients.