Sepsis is associated with radiological lesions in patients with primary brain injuries: the result of a bicentric retrospective cohort.

Abstract

Introduction: The occurrence of sepsis in neurointensive care patients is linked to poor prognosis and high mortality. We hypothesized that an infection or sepsis (I/S) episode might increase the initial number of brain lesions and/or induce new brain lesions in neurointensive care patients.

Materials and methods: This was a retrospective study between January 2015 and June 2020 that included neuroICU patients who had two magnetic resonance images and compared those who presented I/S episodes with those who did not. The two groups' differences were adjusted with propensity score matching. The main composite outcome was the increase in size of the initial brain lesion and/or the appearance of new brain lesions.

Results: A total of 150 neurointensive care patients were included, 50 with infection or sepsis (I/S) and 100 controls. New or worsened brain lesions were observed in 58.0% of the I/S group versus 35.0% of controls (adjusted odds ratio 8.08, 95% CI [3.28-11.29], p < 0.001). Lesions included ischemic strokes (44%), intraparenchymal hemorrhages (44%), and diffuse leukoencephalopathy (52%). Microbleeds were observed in 21.1% of I/S patients. I/S was associated with a longer ICU stay (median 23 vs. 10.5 days, p < 0.0001) and a higher rate of unfavorable outcome (mRS ≥ 4 at discharge: 40.0% vs. 12.0%, p = 0.003; at 1 year: 20.0% vs. 6.5%, p = 0.037). Results were similar in sensitivity analyses restricted to ventilated patients.

Conclusion: The occurrence of I/S is associated with the extension of the initial lesion and/or the appearance of new brain lesions on MRI in patients hospitalized in the neurointensive care unit for primary brain injury.