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Potentially modifiable factors contributing to sepsis-associated encephalopathy

Romain Sonneville| Etienne de Montmollin| Julien Poujade| Maïté Garrouste-Orgeas| Bertrand Souweine| Michael Darmon| Eric Mariotte| Laurent Argaud| François Barbier| Dany Goldgran-Toledano| Guillaume Marcotte| Anne-Sylvie Dumenil| Samir Jamali| Guillaume Lacave| Stéphane Ruckly| Bruno Mourvillier| Jean-François Timsit
Original
Volume 43, Issue 8 / August , 2017

Pages 1075 - 1084

Abstract

Purpose

Identifying modifiable factors for sepsis-associated encephalopathy may help improve patient care and outcomes.

Methods

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.

Results

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).

Conclusions

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.

Keywords

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