Potentially modifiable factors contributing to sepsis-associated encephalopathy

Sonneville, Romain; Montmollin, Étienne de; Poujade, Julien; Garrouste-Orgeas, Maïté; Souweine, Bertrand; Darmon, Michaël; Mariotte, Éric; Argaud, Laurent; Barbier, François; Goldgran-Tolédano, Dany; Marcotte, Guillaume; Dumenil, Anne-Sylvie; Jamali, Samir; Lacave, Guillaume; Ruckly, Stéphane; Mourvillier, Bruno; Timsit, Jean‐François

doi:10.1007/s00134-017-4807-z

Cited by 192 publications

(258 citation statements)

References 38 publications

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“…This larger data observational study has mainly investigated the epidemiological and clinical characteristics of patients with SAE in a general ICU, although several studies have been reported on the epidemiological and prognostic features for SAE in ICU [1,12,13]. Our current study shown that the prevalence of SAE was similar to the epidemiological trend of sepsis, i.e., a peak of the prevalence of SAE was in the onset first day and following few weeks decreased over time.…”

Section: Discussionsupporting

confidence: 62%

Epidemiological and clinical characteristics of sepsis-associated encephalopathy in the ICU: a retrospective observational study

Tong¹,

Zhou²,

Wang³

et al. 2019

Preprint

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Background Sepsis has an annual incidence of 30 million new cases around worldwide. However, the epidemiological and clinical characteristics in patients with sepsis-associated encephalopathy (SAE) remain understudy.Methods We prospectively enrolled patients with acute critically ill from ICU during 2 years period (2014-2015). The epidemiological and clinical characteristics for critically ill adults with SAE in ICU were analyzed by related statistics.Results Of the 1349 ICU patients with acute critically ill, 748 were enrolled. Among these, the prevalence of sepsis was 48.4% (362/748), with fatality at initial 30 days was 62.4%. The prevalence of SAE accounted for 97.2% of sepsis (352/362), with fatality at initial 30 days was 65.1%. We found that the two strong clinical predictors for SAE were systemic inflammatory response syndrome (SIRS) ≥2 (OR, 3.2; 95% CI, 0.304- 0.673) and sequential (sepsis-related) organ function assessment (SOFA) score ≥6 (GCS<13)(OR, 3.0; 95% CI, 0.304-0.673); the sensitivity was 67.3% and specificity was 55.3% for SIRS≥2, while the sensitivity was 99.1% and specificity was 99.0% for SOFA score≥6. Cox logistic adjusted analysis revealed that lower mean arterial pressure (OR, 1.504; 95% CI, 1.001-1.707),higher SOFA score (OR, 1.783; 95% CI, 1.145- 1.923), and no using antibiotics treatment in initial 3 hours (OR, 0.683; 95% CI, 0.492-0.947) were the powerful predictors of the risk of death among ICU patients with SAE.Conclusion SAE is a best frequent epidemiological type of sepsis in ICU, with an high hospital fatality. No using antibiotics treatment within initial 3 hours was related to the worse survival SAE.

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Section: Discussionsupporting

confidence: 62%

Epidemiological and clinical characteristics of sepsis-associated encephalopathy in the ICU: a retrospective observational study

Tong¹,

Zhou²,

Wang³

et al. 2019

Preprint

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“…In this study, we found that the prevalence rate of SAE within initial 48 hours accounted for 93.4 % of sepsis, and the main feature of SAE patients were presented with MODS (96.8%) driven by severe in ammatory storm. Previous studies shown that the prevalence of SAE was 53.0% to 87.0% of sepsis [9,10], and with 63% to 70% of hospital mortality [6,11]. However, our this study is clear: high prevalent SAE is almost near the epidemic rate of sepsis, which indicated the SAE was a leading life-threatening acute organ dysfunction and with 32.0% of fatality at initial 48 hours and 69.1% of fatality at initial 14 days.…”

Section: Discussioncontrasting

confidence: 55%

“…The third, a life-threatening brain failure is almost involved to MODS, and MODS (especially the brain) is the most vulnerable to hypoxia/ ischemia and oxidative stress caused by severe in ammatory storm [19,21]. The previous studies indicated that sepsis with MODS was more likely to exhibit a SAE [9,21,23,24].…”

Section: Discussionmentioning

confidence: 99%

Sepsis-associated Encephalopathy In ICU Admissions: Prevalence, Early Risk of Death, and its Early Prevent and Control

Tong¹,

Wang²,

Wang³

et al. 2020

Preprint

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Background: Sepsis-associated encephalopathy (SAE) is a common encephalopathy in ICU. We are to definite whether SAE present an high prevalence rate and early risk factors for death in ICU 48 hours, while to cognize its important of early prevention/ control.Methods: We retrospectively enrolled patients with acute critically ill from ICU (January, 2015 to January, 2017). All patients were selected from onset to ICU ≤3 hours. The prevalence and some early risk factors of death in SAE was estimated by using a continuous head and thorax /abdominal cavity CT scans. Results: 748 critically ill adults were analyzed. The prevalence of sepsis within initial 48 hours was 40.4% (302/748). The median time from infection to sepsis was 9 hours ( range, 1-48 ). The SAE (93.4%, 282/302) was diagnosed in sepsis patients, and most of them (96.8%) presented multiple organ dysfunction syndromes (MODS). While the fatality of SAE was in 32.0% at initial 48 hours and 69.1% at initial 14 days. Cox regression analysis, unused antibiotic within initial 3 hours (OR, 0.39; 95% CI, 0.22-0.89), severe inflammatory storm (OR, 0.70; 95% CI, 0.58- 0.94), lower GCS (OR, 2.7; 95% CI, 1.5-3.6), and MODS (OR, 0.37; 95% CI, 0.26-0.96) were early risk factors for death in SAE. Early risk factors for predicting SAE were related to severe inflammatory storm (OR, 3.10; 95% CI, 2.28-4.33), MODS (OR, 3.57; 95% CI, 2.73- 4.67), and unused antibiotics within initial 3 hours (OR, 0.25; 95% CI, 0.11-0.56).Conclusions: SAE in ICU is an high prevalent acute brain dysfunction and most with MODS. The early bad prognosis in SAE was related to the failure of early prevention and control.

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“…However, in consistent with their conclusion, Na + did not indicate a meaningful predictive ability for death in patients with sepsis combined with AKI. The metabolic disturbances, including hypernatremia, hypercapnia and elevated lactates, caused by AKI in sepsis was associated with encephalopathy as well [29].…”

Section: Discussionmentioning

confidence: 99%

Predictive Role of Hypernatremia for Acute Kidney Injury in Patients with Sepsis

Zhi

Lin

Dong

et al. 2019

Preprint

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Introduction Septic acute kidney injury (AKI), identified when both sepsis and AKI present, is a syndrome of acute function impairment and organ damage, accounting for ~50% AKI in ICU (Intensive Care Unit)Method This study retrospectively reviewed 591 patients who were diagnosed of sepsis and admitted to the ICU of Beijing Friendship Hospital from January 2009 to December 2014. According to the concentration of serum sodium, the 591 patients were further divided into three groups: normal group, hyponatremia group and hypernatremia group.Result PaCO 2 (P=0.014), concentration of Na + (P<0.001) and Cl - (P<0.001), BUN (P<0.001), APACHE score (P<0.001), SOFA score (P<0.001) and Glasgow score (P<0.001) showed significant differences. CK (P=0.012; OR=1.000), BUN (P=0.002; OR=1.047), Cl - (P<0.001;OR=1.255), lactic acid (P=0.001;OR=1.244), and HCO 3 - (P<0.001;OR=1.180) may be risk factors for hypernatremia in patients with sepsis. APACHE score (P=0.028;OR=1.222) and CK (P=0.014;or=1.003) may be risk factors for AKI in patients with hypernatremia. Na + suggested a good predictive ability for AKI (P<0.001; AUC: 0.586) but not for death (P=0.104)Conclusion Hypernatremia is independently associated with an increased risk and has a predictive ability of AKI in patients with sepsis.

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Potentially modifiable factors contributing to sepsis-associated encephalopathy

Cited by 192 publications

References 38 publications

Epidemiological and clinical characteristics of sepsis-associated encephalopathy in the ICU: a retrospective observational study

Epidemiological and clinical characteristics of sepsis-associated encephalopathy in the ICU: a retrospective observational study

Sepsis-associated Encephalopathy In ICU Admissions: Prevalence, Early Risk of Death, and its Early Prevent and Control

Predictive Role of Hypernatremia for Acute Kidney Injury in Patients with Sepsis

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