Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database
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 O...
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2025-01-01
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| author | 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 on the behalf of the OUTCOME R. E. A. network |
| author_facet | 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 on the behalf of the OUTCOME R. E. A. network |
| author_sort | Michael Thy |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-c5d3c9a0a8e04c97963c1ce25c615915 |
| institution | Kabale University |
| issn | 2052-0492 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Journal of Intensive Care |
| spelling | doaj-art-c5d3c9a0a8e04c97963c1ce25c6159152025-01-19T12:11:59ZengBMCJournal of Intensive Care2052-04922025-01-011311910.1186/s40560-024-00773-9Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA databaseMichael Thy0Romain Sonneville1Stéphane Ruckly2Bruno Mourvillier3Carole Schwebel4Yves Cohen5Maité Garrouste-Orgeas6Shidasp Siami7Cédric Bruel8Jean Reignier9Elie Azoulay10Laurent Argaud11Dany Goldgran-Toledano12Virginie Laurent13Claire Dupuis14Julien Poujade15Lila Bouadma16Etienne de Montmollin17Jean-François Timsit18on the behalf of the OUTCOME R. E. A. networkMedical and Infectious Diseases, ICU, Hospital Bichat-Claude Bernard, Université Paris Cité, AP-HPMedical and Infectious Diseases, ICU, Hospital Bichat-Claude Bernard, Université Paris Cité, AP-HPUMR 1137, INSERM, Université Paris CitéIntensive Care Unit, CHU Reims-Champagne ClinicMedical Intensive Care Unit, C.H.U de GrenobleRespiratory Department, Avicenne Hospital (AP-HP)Intensive Care Unit, Hospital Franco-Britannique, Fondation Cognacq-JayRéanimation, Hospital Center Sud EssonneMedical and Surgical Intensive Care Unit, Hospital Paris Saint-JosephIntensive Care Unit, Nantes University Hospital Hotel-DieuMedical Intensive Care Unit, Hospital Saint-LouisIntensive Care Unit, Hospital Édouard HerriotIntensive Care Unit, Intercommunal Hospital Group Le Raincy MontfermeilIntensive Care Unit, C.H. de VersaillesIntensive Care Unit, CHU Gabriel-MontpiedMedical and Infectious Diseases, ICU, Hospital Bichat-Claude Bernard, Université Paris Cité, AP-HPMedical and Infectious Diseases, ICU, Hospital Bichat-Claude Bernard, Université Paris Cité, AP-HPMedical and Infectious Diseases, ICU, Hospital Bichat-Claude Bernard, Université Paris Cité, AP-HPMedical and Infectious Diseases, ICU, Hospital Bichat-Claude Bernard, Université Paris Cité, AP-HPAbstract 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.https://doi.org/10.1186/s40560-024-00773-9Critical careSecondary brain injuryEarly systemic insultsSepsisEncephalopathy |
| spellingShingle | 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 on the behalf of the OUTCOME R. E. A. network Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database Journal of Intensive Care Critical care Secondary brain injury Early systemic insults Sepsis Encephalopathy |
| title | Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database |
| title_full | Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database |
| title_fullStr | Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database |
| title_full_unstemmed | Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database |
| title_short | Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database |
| title_sort | early systemic insults following severe sepsis associated encephalopathy of critically ill patients association with mortality and awakening an analysis of the outcomerea database |
| topic | Critical care Secondary brain injury Early systemic insults Sepsis Encephalopathy |
| url | https://doi.org/10.1186/s40560-024-00773-9 |
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