Sepsis in intensive care unit patients with traumatic brain injury: factors associated with higher mortality

Júnior, Luis Carlos Maia Cardozo; Silva, Redson Ruy da

doi:10.5935/0103-507x.20140022

Cited by 32 publications

(24 citation statements)

References 15 publications

(18 reference statements)

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“…As for length of stay, patients with sepsis, severe sepsis and septic shock stayed for 19.5 to 23.6 days in the intensive care unit. These results differ from other national (14) and international (5,7) data that identified lengths of stay varying from 3.2 to 15.4 days.…”

Section: Discussioncontrasting

confidence: 99%

Fatores de risco para morte em pacientes com sepse em uma unidade de terapia intensiva

Prado¹,

Volpáti²,

Gimenes³

et al. 2018

Rev Rene

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Objetivo: determinar os principais fatores de risco para a morte em pacientes com sepse em uma unidade de terapia intensiva. Métodos: trata-se de uma coorte retrospectiva, onde foram incluídos 124 prontuários de pacientes que tiveram diagnóstico clínico e laboratorial de sepse. A probabilidade condicional de morte foi calculada através do método de Kaplan-Meier; o risco de morte foi estimado pela razão de risco, utilizando modelo de regressão de Cox com p<0,050. Resultados: o foco principal da infecção foi o sistema respiratório. Em relação ao desfecho, morreram 40,3% pacientes com sepse, 73,9% com sepse grave e 69,2% com choque séptico. Os pacientes com sepse abdominal e que utilizaram vasopressores apresentaram maior risco de morte. Conclusão: pacientes sépticos com fonte abdominal de infecção e fazendo uso de agentes vasopressores apresentaram maior risco de morte, enquanto que pacientes traqueostomizados tiveram melhores chances de sobreviver.

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Section: Discussioncontrasting

confidence: 99%

Fatores de risco para morte em pacientes com sepse em uma unidade de terapia intensiva

Prado¹,

Volpáti²,

Gimenes³

et al. 2018

Rev Rene

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“…The novelty of this study is a first to report that 97.2% of sepsis patients had a SABD with bad outcome, and unused a rapid antibiotic treatment within the initial 0.5 to 3.0 hours after an early suspected infection event plays a vital role in advancement of high morbidity and high risk of death in SABD. In addition, this high prevalence of SABD with bad outcome can also be explained by the following several points: (1) the low prevalence of SAE in the ICU was from a population without stroke or traumatic brain injure [11,12], whereas, our current study is included these septic patients from stroke and trauma [2,13,15]; (2) our SABD patients were generally associated with a SIRS ≥2, which involves the pathogenesis of SABD contributed by Bone [27], i.e., the cytokines lead to blood brain barrier leakage and cell death [28]. A mixed SABD can be considered if accompanied by a primary brain injure; (3) most SABD in our series is presented with MODS, and the previous studies also indicated that sepsis patients with MODS were more likely to exhibit a SAE [12,21,29,30].…”

Section: Discussionmentioning

confidence: 99%

“…Whereas, some epidemic studies of SAE showed that a low prevalence varies from 17.7% to 53% of patients with sepsis in ICU, which is unfortunately ruled out stroke or traumatic patients [11,12]. Indeed, acute stroke and traumatic brain injury is more likely to have a secondary sepsis [2,[13][14][15]. However, whether the prevalence of sepsis in ICU patients with critically ill, including acute stroke and traumatic brain injury, would present a leading high prevalence of SABD, which is still unknown.…”

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confidence: 99%

Prevalence and risk factors for death in sepsis- associated brain dysfunction: a retrospective study from ICU admissions

Tong

Zhou²,

Wang

2020

Preprint

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Background: The prevalence of sepsis-associated brain dysfunction (SABD) in ICU patients with critically ill remains unknown. We are to assess whether the prevalence of sepsis in ICU would present a high prevalent life- threatening SABD. Methods: We enrolled acute critically ill adults patients from ICU (from January 1, 2015, to January 1, 2017). All patients were selected from onset to ICU ≤3 hours and followed up to 30 day for sepsis patients who were treated in initial 48 hours or more in ICU. The predictors and risk of death of SABD was analyzed by multivariate models. Results: Of the 1349 ICU patients with acute critically ill, 748 were enrolled. Among these, the prevalence of sepsis was 48.4% (362/748). The prevalence of SABD accounted for 97.2% of sepsis (352/362), with fatality at initial 30 days was 73.6%. We found that the strong clinical predictors or markers for SABD were a SIRS ≥2 (OR, 3.2; 95% CI, 1.7-6.1), SOFA score ≥6 (OR, 3.0; 95% CI, 2.6-3.5), and qSOFA score ≥2 (OR, 0.34; 95% CI, 0.16-0.58). Cox logistic adjusted analysis revealed that lower mean arterial pressure (MAP) (OR, 1.5; 95% CI, 1.0-1.7)，higher SOFA score (OR, 1.8; 95% CI, 1.1- 1.9), and unused a rapid antibiotics treatment in initial 3 hours (OR, 0.7; 95% CI, 0.5-0.9) were the predictors of the risk of death among ICU patients with SABD. Conclusions: SABD is a leading life-threatening organ dysfunction following critically ill in ICU, with an high fatality. The predictors for worse survival SABD were related to the lower MAP, higher SOFA scores, and unused a rapid antibiotic treatment within initial 3 hours.

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“…3 Other pulmonary complications, such as acute respiratory distress syndrome (ARDS), pulmonary embolism (PE), and sepsis, were reported to be $ 20%, 1 to 4%, and 50%, respectively. [4][5][6][7] Complications arising in patients with a combination of a severe TBI and an acute subdural hematoma (SDH) can be fatal. 8,9 Early intervention, including prevention of secondary injury to the brain by proactive medical management, is the key to manage the outcomes of these patients.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Complications and Sepsis Following Severe Acute Subdural Hematoma in Patients Who Underwent Craniotomy versus Craniectomy: A Propensity Score Matched Analysis

Ahmed

Greenberg

Shin

2020

J Neurol Surg A Cent Eur Neurosurg

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Background The purpose of the study was to evaluate the impact of craniotomy (CO) and decompressive craniectomy (DC) for evacuation of acute subdural hematoma (SDH) on pulmonary complications and sepsis. Methods Study data were obtained from the National Trauma Data Bank (2007–2010). Only patients who met all of the following criteria were included in this analysis: sustained blunt injuries, presented with severe traumatic brain injury, sustained an associated SDH, presented with an initial Glasgow Coma Scale (GCS) score ≤ 8 and an Abbreviated Injury Scale score of head ≥ 3, and underwent a CO or DC within 4 hours of hospital arrival. Patient characteristics and outcomes were compared between CO and DC, the two procedural groups. The data were first compared between the two unmatched groups; then propensity score matching and a matched pairs analysis were performed. Results From the total population of 2,370 patients, 1,852 (78%) of them underwent CO, and the remaining 518 (22%) underwent DC. Some differences were found between the CO and DC groups regarding age (mean [standard deviation (SD)]: 47.9 years [22.8] versus 39.6 years [20.1]; p < 0.001), sex (male: 70.1% versus 74.7%; p = 0.05), race (white: 77.4% versus 73.4%; p = 0.06), the injury mechanism (fall: 50.7% versus 33.2%; p < 0.001), Injury Severity Score (mean [SD]: 28.0 [9.3] versus 30.5 [10.0]; p < 0.001), and GCS score (median [interquartile range] 3 [3–5] versus 3 [3–4])). After the propensity score matching, no significant differences were found between the groups on the variables just listed (all p > 0.05). No significant differences were seen between the CO and DC groups in the incidences of these conditions: acute respiratory distress syndrome (ARDS) (12.0% versus 8.1%; p = 0.20), pneumonia (34.9% versus 37.6%; p = 0.60), pulmonary embolism (PE) (3.5% versus 1.6%; p = 0.30), and systemic sepsis (6.2% versus 8.1%; p = 0.5). Conclusion Although most of the patients underwent CO for acute SDH, no significant differences were observed in the incidence of ARDS, pneumonia, PE, or systemic sepsis when compared with patients who underwent DC.

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Sepsis in intensive care unit patients with traumatic brain injury: factors associated with higher mortality

Cited by 32 publications

References 15 publications

Fatores de risco para morte em pacientes com sepse em uma unidade de terapia intensiva

Fatores de risco para morte em pacientes com sepse em uma unidade de terapia intensiva

Prevalence and risk factors for death in sepsis- associated brain dysfunction: a retrospective study from ICU admissions

Pulmonary Complications and Sepsis Following Severe Acute Subdural Hematoma in Patients Who Underwent Craniotomy versus Craniectomy: A Propensity Score Matched Analysis

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