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
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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 (PaO<sub>2</sub> < 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"5"},"PeriodicalIF":3.8000,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730477/pdf/","citationCount":"0","resultStr":"{\"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\":\"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\",\"doi\":\"10.1186/s40560-024-00773-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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><p><strong>Methods: </strong>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 (PaO<sub>2</sub> < 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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>\",\"PeriodicalId\":16123,\"journal\":{\"name\":\"Journal of Intensive Care\",\"volume\":\"13 1\",\"pages\":\"5\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-01-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730477/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Intensive Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s40560-024-00773-9\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40560-024-00773-9","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景：脓毒症相关脑病（SAE）可能因早期全身损伤而恶化。我们的目的是研究早期系统性损伤与严重SAE危重患者预后的关系。方法：我们使用来自法国OUTCOMEREA前瞻性多中心数据库的数据进行回顾性分析。我们纳入了在重症监护病房（ICU）住院至少48小时的严重SAE患者（根据格拉斯哥昏迷量表（GCS）评分≤13分和严重脓毒症或脓毒性休克（脓毒症2.0标准）定义），需要有创通气且无原发性脑损伤。我们分析了早期的全身损伤(血糖异常（2 200 mmHg），二氧化碳异常(13。结果：我们纳入了995例严重SAE患者，其中883例（89%）表现出至少一次持续到第3天的早期系统性损伤。与非幸存者相比，幸存者在ICU入院的前48小时内出现的早期全身性损伤（低血糖、低血压、低体温和贫血）显著减少。未在第3天纠正以下系统性损伤与死亡率独立相关：血压(校正危险比（aHR) = 1.77, 95%可信区间（CI） 1.34-2.34）、氧合（aHR = 1.78, 95% CI 1.20-2.63）、体温（aHR = 1.46, 95% CI 1.12-1.91）和血糖（aHR = 1.41, 95% CI 1.10-1.80）。第3天持续的血压、体温和血糖异常与觉醒的机会减少有关。结论：在严重SAE患者中，在ICU入院的前三天内持续的全身损伤与死亡率增加和觉醒机会降低相关。
Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening-an analysis of the OUTCOMEREA database.
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.
期刊介绍：
"Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction.
Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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