Sepsis-associated encephalopathy: A review of literature

Molnár, L.; Fülesdi, Béla; Németh, Norbert; Molnár, Csilla

doi:10.4103/0028-3886.227299

Cited by 65 publications

(22 citation statements)

References 103 publications

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“…There is evidence that the circulatory shock usually coexists with coagulopathy and the latter is a good prognostic marker for survival outcome [33, 34]. Sepsis-associated encephalopathy (SAE) is an important complication of sepsis [35] and can occur in up to 82% of patients with sepsis [36]. SAE presents with varying severity ranging from mild confusion to coma.…”

Section: Discussionmentioning

confidence: 99%

Identification of subclasses of sepsis that showed different clinical outcomes and responses to amount of fluid resuscitation: a latent profile analysis

Zhang

Goyal

et al. 2018

Crit Care

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Background and objectiveSepsis is a heterogeneous disease and identification of its subclasses may facilitate and optimize clinical management. This study aimed to identify subclasses of sepsis and its responses to different amounts of fluid resuscitation.MethodsThis was a retrospective study conducted in an intensive care unit at a large tertiary care hospital. The patients fulfilling the diagnostic criteria of sepsis from June 1, 2001 to October 31, 2012 were included. Clinical and laboratory variables were used to perform the latent profile analysis (LPA). A multivariable logistic regression model was used to explore the independent association of fluid input and mortality outcome.ResultsIn total, 14,993 patients were included in the study. The LPA identified four subclasses of sepsis: profile 1 was characterized by the lowest mortality rate and having the largest proportion and was considered the baseline type; profile 2 was characterized by respiratory dysfunction; profile 3 was characterized by multiple organ dysfunction (kidney, coagulation, liver, and shock), and profile 4 was characterized by neurological dysfunction. Profile 3 showed the highest mortality rate (45.4%), followed by profile 4 (27.4%), 2 (18.2%), and 1 (16.9%). Overall, the amount of fluid needed for resuscitation was the largest on day 1 (median 5115 mL, interquartile range (IQR) 2662 to 8800 mL) and decreased rapidly on day 2 (median 2140 mL, IQR 900 to 3872 mL). Higher cumulative fluid input in the first 48 h was associated with reduced risk of hospital mortality for profile 3 (odds ratio (OR) 0.89, 95% CI 0.83 to 0.95 for each 1000 mL increase in fluid input) and with increased risk of death for profile 4 (OR 1.20, 95% CI 1.11 to 1.30).ConclusionThe study identified four subphenotypes of sepsis, which showed different mortality outcomes and responses to fluid resuscitation. Prospective trials are needed to validate our findings.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2279-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Identification of subclasses of sepsis that showed different clinical outcomes and responses to amount of fluid resuscitation: a latent profile analysis

Zhang

Goyal

et al. 2018

Crit Care

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“…Clinically, SAE is manifested in two different forms: an early predictable form and a late form, which is usually accompanied by complex metabolic encephalopathy that can lead to irreversible brain damage [ 11 ]. It is noteworthy that sometimes SAE is associated with high levels of aromatic amino acids (AAA) in plasma [ 32 ] as a consequence of energy deficit, which in turn causes a breakdown of the metabolic pathways related to gluconeogenesis and obtain energy in muscle [ 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

Role of microRNAs As Biomarkers in Sepsis-Associated Encephalopathy

et al. 2021

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Sepsis-associated encephalopathy (SAE) is a neurological complication of sepsis, characterized by brain dysfunction without any direct central nervous system infection. The diagnosis of SAE is currently a challenge. In fact, problems in making a diagnosis of SAE cause a great variability of incidence that can reach up to 70% of all septic patients. Even more, despite SAE is the most frequent type of encephalopathy occurring in critically ill patients, the molecular mechanisms that guide its progression have not been completely elucidated. On the other hand, miRNAs have proven to be excellent biomarkers for both diagnosis and prognosis, especially in brain pathologies because of their small size they can cross the blood–brain barrier easier than other biomolecules. The identification of new miRNAs as biomarkers may help to improve SAE diagnosis and prognosis and also to design new therapies for this clinical manifestation that produces diffuse cerebral dysfunction. This review is focused on SAE physiopathology and the need to have clear criteria for its diagnosis; thus, this work postulates some miRNA candidates to be used for SAE biomarkers because of their role in both, neurological damage and sepsis.

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“…For example, during SAE, synaptic activity is significantly reduced. Since GABA-A receptors participate in most neuronal inhibitory synapses, GABA-A may become a new target for the prevention and treatment of delirium (Molnar et al, 2018).…”

Section: Treatment Of Saementioning

confidence: 99%

Microglia: A Potential Therapeutic Target for Sepsis-Associated Encephalopathy and Sepsis-Associated Chronic Pain

Yin

Fan

et al. 2020

Front. Pharmacol.

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Neurological dysfunction, one of the severe manifestations of sepsis in patients, is closely related to increased mortality and long-term complications in intensive care units, including sepsis-associated encephalopathy (SAE) and chronic pain. The underlying mechanisms of these sepsis-induced neurological dysfunctions are elusive. However, it has been well established that microglia, the dominant resident immune cell in the central nervous system, play essential roles in the initiation and development of SAE and chronic pain. Microglia can be activated by inflammatory mediators, adjacent cells and neurotransmitters in the acute phase of sepsis and then induce neuronal dysfunction in the brain. With the spotlight focused on the relationship between microglia and sepsis, a deeper understanding of microglia in SAE and chronic pain can be achieved. More importantly, clarifying the mechanisms of sepsis-associated signaling pathways in microglia would shed new light on treatment strategies for SAE and chronic pain.

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Sepsis-associated encephalopathy: A review of literature

Cited by 65 publications

References 103 publications

Identification of subclasses of sepsis that showed different clinical outcomes and responses to amount of fluid resuscitation: a latent profile analysis

Identification of subclasses of sepsis that showed different clinical outcomes and responses to amount of fluid resuscitation: a latent profile analysis

Role of microRNAs As Biomarkers in Sepsis-Associated Encephalopathy

Microglia: A Potential Therapeutic Target for Sepsis-Associated Encephalopathy and Sepsis-Associated Chronic Pain

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