Clinical Features and Factors Associated With Sepsis-Associated Encephalopathy in Children: Retrospective Single-Center Clinical Study

Abstract

BackgroundSepsis-associated encephalopathy (SAE) is a common complication in septic patients with a higher ICU and hospital mortality in adults and poorer long-term outcomes. Clinical presentation may range from mild confusion to convulsions and deep coma; however, little is known about SAE in children. We aimed to retrospectively analyze the data for children with sepsis, to illustrate the epidemiology, performance, and adverse outcome, and to evaluate the association between risk factors and SAE in children.MethodsAll children with sepsis who were admitted to the Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China from January 2010 to December 2020 were retrospectively analyzed.ResultsA total of 210 patients with sepsis were retrospectively assigned to the SAE and non-SAE groups, of which 91 (43.33%) were diagnosed with SAE with a mortality of 6.70% (14/210). Significant differences were observed in the level of white blood platelet, platelets, international normalized ratio, prothrombin time, activated partial thromboplastin time, total protein, Ccr, UREA, blood urea nitrogen, alanine transaminase, aspartate transaminase, creatine kinase, creatine kinase isoenzymes, lactate dehydrogenase, procalcitonin, and lactic acid (p < 0.05). In the risk assessment scales, significant differences were observed in the modified Glasgow Coma score, PCIS, Pediatric Logistic Organ Dysfunction Score 2 (PELOD-2), Pediatric Sequential Organ Failure Assessment Score, and Pediatric Risk of Mortality III (p < 0.05). The incidence of septic shock, acute kidney disease, liver dysfunction, and coagulation disorder were higher in the SAE group (p < 0.05). The mechanical ventilation time ([6.57 d ± 16.86 d] vs. [2.05 d ± 5.79 d]; p < 0.001), CRRT time ([1.74 d ± 6.77 d] vs. [0.11 d ± 0.63 d]; p < 0.001), ICU stay time ([299.90 h ± 449.50 h] vs. [177.67 h ± 245.36 h]); p < 0.001 was longer than that of non-SAE. Both the PCT, Ca2+, septic shock, PELOD-2, and midazolam were identified as independent risk factors, and fentanyl was a protective factor for SAE in pediatric patients (p < 0.05). The main clinical neurological symptoms consisted of agitation, hypnosia, hypnosis alternates agitated, anterior fontanelle full/bulging/high tension, coma, muscle hypertonia, muscle hypotonia, hyperreflexia, focal seizure, and generalized seizure.ConclusionsThe incidence of SAE in children was found high and the prognosis poor. In this retrospective study, the identified patients were more susceptible to SAE, with an inflammatory storm with hypocalcemia or septic shock. The use of midazolam will increase the occurrence of SAE, whereas fentanyl will reduce the incidence of SAE, and PELOD-2 may predict the occurrence of SAE.

Development and validation of a nomogram to predict the risk of sepsis-associated encephalopathy for septic patients in PICU: a multicenter retrospective cohort study

“…A previous study among adult patients with sepsis found that acute renal failure, hypoglycemia, hypercapnia, hypernatremia, and S. aureus infection were independent predictors of SAE [ 19 ], and the different results from our study demonstrated a difference between adult and pediatric patients. Another retrospective single-center study of 210 pediatric patients with sepsis showed that procalcitonin, Ca 2+ , septic shock, pediatric logistic organ dysfunction score 2 (PELOD-2), and midazolam were independent risk factors for SAE; however, no comprehensive predictive model has been developed [ 20 ]. Moreover, our study showed that SAE was associated with higher in-hospital mortality and higher use of ICU resources, confirming the early predictive value of SAE at PICU admission.…”

“…As one of the most commonly used indicators of the endogenous coagulation system in clinical practice, APTT was previously shown to be significantly increased in children with SAE compared to those without [ 20 ]. Similarly, in the present study, APTT was significantly associated with the occurrence of SAE ( P < 0.001) and was included in the prediction nomogram because of its strong influence.…”

“…Another study which included 9126 patients with sepsis reported that BUN was an independent and easily available predictor of 28-day mortality in critically ill patients with sepsis admitted to the ICU [ 26 ]. Furthermore, BUN was found to be correlated with the severity and mortality of SAE [ 20 , 27 , 28 ] and proven to be a risk factor related to the in-hospital mortality of patients with sepsis in other models [ 25 , 29 ]. Accordingly, it is advisable that normal renal function is maintained to reduce the occurrence of SAE and mortality in patients with SAE.…”

Diagnostic Identification of Acute Brain Dysfunction in Pediatric Sepsis and Septic Shock in the Electronic Health Record: A Comparison of Four Definitions in a Reference Dataset*

“…The clinical pathophysiology of the progression of brain dysfunction is likely multifactorial and associated with more severe illness characterized by early neurologic dysfunction (2) and persistent hypoxemia (3). This neurologic entity goes by a variety of terms including sepsis-associated encephalopathy, sepsis-induced brain dysfunction, or sepsis-associated delirium (4), the cause of which may be as widespread as direct infection, structural brain lesions, metabolic and biochemical derangement, pharmacologic exposures, and inflammation (4)(5)(6).…”