We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Potentially modifiable factors contributing to sepsis-associated encephalopathy.
- Authors
Sonneville, Romain; Montmollin, Etienne; Poujade, Julien; Garrouste-Orgeas, Maïté; Souweine, Bertrand; Darmon, Michael; Mariotte, Eric; Argaud, Laurent; Barbier, François; Goldgran-Toledano, Dany; Marcotte, Guillaume; Dumenil, Anne-Sylvie; Jamali, Samir; Lacave, Guillaume; Ruckly, Stéphane; Mourvillier, Bruno; Timsit, Jean-François; de Montmollin, Etienne
- Abstract
<bold>Purpose: </bold>Identifying modifiable factors for sepsis-associated encephalopathy may help improve patient care and outcomes.<bold>Methods: </bold>We conducted a retrospective analysis of a prospective multicenter database. Sepsis-associated encephalopathy (SAE) was defined by a score on the Glasgow coma scale (GCS) <15 or when features of delirium were noted. Potentially modifiable risk factors for SAE at ICU admission and its impact on mortality were investigated using multivariate logistic regression analysis and Cox proportional hazard modeling, respectively.<bold>Results: </bold>We included 2513 patients with sepsis at ICU admission, of whom 1341 (53%) had sepsis-associated encephalopathy. After adjusting for baseline characteristics, site of infection, and type of admission, the following factors remained independently associated with sepsis-associated encephalopathy: acute renal failure [adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) 1.19-1.67], hypoglycemia <3 mmol/l (aOR = 2.66, 95% CI 1.27-5.59), hyperglycemia >10 mmol/l (aOR = 1.37, 95% CI 1.09-1.72), hypercapnia >45 mmHg (aOR = 1.91, 95% CI 1.53-2.38), hypernatremia >145 mmol/l (aOR = 2.30, 95% CI 1.48-3.57), and S. aureus (aOR = 1.54, 95% CI 1.05-2.25). Sepsis-associated encephalopathy was associated with higher mortality, higher use of ICU resources, and longer hospital stay. After adjusting for age, comorbidities, year of admission, and non-neurological SOFA score, even mild alteration of mental status (i.e., a score on the GCS of 13-14) remained independently associated with mortality (adjusted hazard ratio = 1.38, 95% CI 1.09-1.76).<bold>Conclusions: </bold>Acute renal failure and common metabolic disturbances represent potentially modifiable factors contributing to sepsis-associated encephalopathy. However, a true causal relationship has yet to be demonstrated. Our study confirms the prognostic significance of mild alteration of mental status in patients with sepsis.
- Subjects
SEPSIS; DELIRIUM; GLASGOW Coma Scale; MULTIVARIATE analysis; ACUTE kidney failure; DISEASE risk factors; THERAPEUTICS; BRAIN diseases; COMPARATIVE studies; HEALTH status indicators; LENGTH of stay in hospitals; INTENSIVE care units; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; METABOLIC disorders; RESEARCH; EVALUATION research; PROPORTIONAL hazards models; RETROSPECTIVE studies
- Publication
Intensive Care Medicine, 2017, Vol 43, Issue 8, p1075
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-017-4807-z