Factors Associated With Short and Long Term Cognitive Changes in Patients With Sepsis

Abstract

This study aimed to assess cognition in patients with severe sepsis or septic shock and whether cognitive impairment was associated with clinical and laboratory parameters. We conducted a cohort study of patients with severe sepsis and septic shock evaluated within 24 h and one year after ICU discharge. Demographic, clinical and laboratory data were analyzed, and the following neuropsychological tests were applied: Consortium to Establish Registry for Alzheimer’s Disease, Mini-Mental State Examination, and Trail Making Test forms A and B. We included 33 patients, mean age of 49, 19% were female. Patients underperformed on most measures 24 h after ICU discharge, with improvement on follow-up. IQCODE, APACHE II scores, NSE and IFN-γ levels at ICU discharge were associated with poor cognitive performance, while higher educational level was associated with good cognitive performance. The time to first antibiotic dose, accumulated dose of haloperidol during UCI stay and mean glycemia were also associated with poor cognitive outcome. In general, patients with severe sepsis or septic shock have cognitive impairment that can improve over time. This improvement was associated with factors identified during their ICU stay, such as cognitive reserve, educational level, mean glycemia during ICU stay and NSE level.

Circulating heparan sulfate fragments mediate septic cognitive dysfunction

“…Septic patients frequently experience cognitive dysfunction that persists beyond hospital discharge, impairing survivors' quality of life and ability to return to work (1)(2)(3). This cognitive impairment has been largely attributed to brain injury occurring early in sepsis, arising from pathogenic processes including cerebral microvascular thrombosis, metabolic derangements, and IL-1β-dependent neuroinflammation (4)(5)(6)(7)(8).…”

A Cecal Slurry Mouse Model of Sepsis Leads to Acute Consumption of Vitamin C in the Brain

“…Overall survivability during sepsis is dependent on a variety of factors including antibiotics administration, prior health status, prior injury or illness, and age [64]. While maintenance of ASC levels during sepsis may not directly impact acute survival, it may be critical to protection against inflammatory damage following sepsis, especially in the brain [14]. Future studies will seek to understand how ASC is involved in the acute inflammatory response and the implications for long term cognitive dysfunction following recovery.…”

“…The brain is particularly susceptible to this dysregulated inflammatory response and to suboptimal ASC levels, because higher oxidative stress levels in the brain are especially damaging to its enriched lipid composition and nutrient-demanding metabolic rate [12,13]. Up to 30% of patients are reported to experience cognitive deficits following recovery from sepsis [14][15][16], and several studies using rodent sepsis models have shown that acute illness damages cognition in surviving animals [17][18][19].…”

Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers

“…Given the benefits offered by the rational use of antibiotics, including the reduction of multiresistant bacteria 5,29,30 , treatment costs 31 , frequency of adverse effects 32 , and less interference with microbiome, objective criteria to define the ideal treatment length is warranted. CRP is a low-cost and affordable biomarker 10 , routinely used in intensive care, that has been shown relate to prognosis in studies involving different populations with serious infectious conditions 17,20,33,34 .…”