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- Title
Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database.
- Authors
Thy, Michael; Sonneville, Romain; Ruckly, Stéphane; Mourvillier, Bruno; Schwebel, Carole; Cohen, Yves; Garrouste-Orgeas, Maité; Siami, Shidasp; Bruel, Cédric; Reignier, Jean; Azoulay, Elie; Argaud, Laurent; Goldgran-Toledano, Dany; Laurent, Virginie; Dupuis, Claire; Poujade, Julien; Bouadma, Lila; de Montmollin, Etienne; Timsit, Jean-François
- Abstract
Background: Sepsis-associated encephalopathy (SAE) may be worsened by early systemic insults. We aimed to investigate the association of early systemic insults with outcomes of critically ill patients with severe SAE. Methods: We performed a retrospective analysis using data from the French OUTCOMEREA prospective multicenter database. We included patients hospitalized in intensive care unit (ICU) for at least 48 h with severe SAE (defined by a score on the Glasgow Coma Scale (GCS) ≤ 13 and severe sepsis or septic shock (SEPSIS 2.0 criteria)) requiring invasive ventilation and who had no primary brain injury. We analyzed early systemic insults (abnormal glycemia (< 3 mmol/L or ≥ 11 mmol/L), hypotension (diastolic blood pressure ≤ 50 mmHg), temperature abnormalities (< 36 °C or ≥ 38.3 °C), anemia (hematocrit < 21%), dysnatremia (< 135 mmol/L or ≥ 145 mmol/L), oxygenation abnormalities (PaO2 < 60 or > 200 mmHg), carbon dioxide abnormalities (< 35 mmHg or ≥ 45 mmHg), and the impact of their correction at day 3 on day-28 mortality and awakening, defined as a recovery of GCS > 13. Results: We included 995 patients with severe SAE, of whom 883 (89%) exhibited at least one early systemic insult that persisted through day 3. Compared to non-survivors, survivors had significantly less early systemic insults (hypoglycemia, hypotension, hypothermia, and anemia) within the first 48 h of ICU admission. The absence of correction of the following systemic insults at day 3 was independently associated with mortality: blood pressure (adjusted hazard ratio (aHR) = 1.77, 95% confidence interval (CI) 1.34–2.34), oxygenation (aHR = 1.78, 95% CI 1.20–2.63), temperature (aHR = 1.46, 95% CI 1.12–1.91) and glycemia (aHR = 1.41, 95% CI 1.10–1.80). Persistent abnormal blood pressure, temperature and glycemia at day 3 were associated with decreased chances of awakening. Conclusions: In patients with severe SAE, the persistence of systemic insults within the first three days of ICU admission is associated with increased mortality and decreased chances of awakening. Key points: Question: Sepsis-associated encephalopathy (SAE) may be worsened by early systemic insults. We aimed to investigate the association of early systemic insults with outcomes of critically ill patients with severe SAE. Findings: In patients with a severe sepsis-associated encephalopathy, early systemic insults were frequent and failure to correct them (especially blood pressure, oxygenation, temperature and glycemia) within the first 3 days of ICU admission was associated with increased mortality and decreased chances of awakening at day 28. Meaning: Early correction of systemic insults in patients with SAE may be one of the targets for better outcomes.
- Subjects
DIASTOLIC blood pressure; INTENSIVE care patients; GLASGOW Coma Scale; INVECTIVE; SEPTIC shock
- Publication
Journal of Intensive Care, 2025, Vol 13, Issue 1, p1
- ISSN
2052-0492
- Publication type
Academic Journal
- DOI
10.1186/s40560-024-00773-9