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Background <p>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.</p> Methods <p>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&#xa0;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.</p> <p>We analyzed early systemic insults (abnormal glycemia (&lt; 3&#xa0;mmol/L or ≥ 11&#xa0;mmol/L), hypotension (diastolic blood pressure ≤ 50&#xa0;mmHg), temperature abnormalities (&lt; 36&#xa0;°C or ≥ 38.3&#xa0;°C), anemia (hematocrit &lt; 21%), dysnatremia (&lt; 135&#xa0;mmol/L or ≥ 145&#xa0;mmol/L), oxygenation abnormalities (PaO<sub>2</sub> &lt; 60 or &gt; 200&#xa0;mmHg), carbon dioxide abnormalities (&lt; 35&#xa0;mmHg or ≥ 45&#xa0;mmHg), and the impact of their correction at day 3 on day-28 mortality and awakening, defined as a recovery of GCS &gt; 13.</p> Results <p>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&#xa0;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.</p> Conclusions <p>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.</p>

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Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database

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  • 发表日期：

    2025年1月14日

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  • Michael Thy,
  • Romain Sonneville,
  • Stéphane Ruckly,
  • Bruno Mourvillier,
  • Carole Schwebel,
  • Yves Cohen,
  • Maité Garrouste-Orgeas,
  • Shidasp Siami,
  • Cédric Bruel,
  • Jean Reignier,
  • Elie Azoulay,
  • Laurent Argaud,
  • Dany Goldgran-Toledano,
  • Virginie Laurent,
  • Claire Dupuis,
  • Julien Poujade,
  • Lila Bouadma,
  • Etienne de Montmollin,
  • Jean-François Timsit

摘要

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.