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

Abstract

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.