Abstract
<title>Abstract</title> <p> <bold>Background</bold> Altered consciousness is a common neurological emergency in intensive care units (ICUs) and is associated with substantial morbidity and mortality. Evidence regarding its causes and outcomes in resource-limited settings remains limited. This study aimed to evaluate the etiological spectrum, clinical characteristics, and predictors of mortality among adult Syrian ICU patients presenting with altered consciousness. <bold>Methods</bold> A retrospective cohort study was conducted in the ICU of the National University Hospital, Damascus, Syria, between April 2024 and April 2025. Adult patients with altered consciousness at admission or during ICU stay were included. Multivariate logistic regression analysis was used to identify independent predictors of ICU mortality. <bold>Results</bold> A total of 110 patients were included (mean age 54.3 ± 18.4 years; 58.2% male). Altered consciousness was present at admission in 65.5% of patients, while 50.9% had severe neurological impairment (Glasgow Coma Scale [GCS] ≤ 8). The most common etiologies were cerebrovascular disease (21.8%), metabolic encephalopathy (20.0%), and sepsis (18.2%). Overall ICU mortality was 36.4%. Multivariate analysis identified GCS ≤8 as the strongest predictor of mortality (AOR = 5.125, 95% CI: 2.455–10.564, p = 0.001). Additional independent risk factors included male sex (AOR = 2.964, p = 0.015), ICU-acquired sepsis (AOR = 2.864, p = 0.003), mechanical ventilation (AOR = 2.731, p = 0.004), infectious etiology (AOR = 2.536, p = 0.007), and age ≥50 years (AOR = 2.000, p = 0.040). <bold>Conclusions</bold> Altered consciousness is associated with high mortality among critically ill patients. Severe neurological impairment at presentation, sepsis, mechanical ventilation, male sex, and older age were significant predictors of death. Early identification of high-risk patients and prompt management of infectious complications may improve outcomes in resource-limited ICU settings. </p>