Neurologic Features and Risk Factors of Sepsis Associated Brain Dysfunction With Worse Outcomes in ICU: A Cohort Study From Quick Diagnostic Tests

Background: Sepsis is a life-threatening organ dysfunction caused by infection. What is the neurologic features and risk factors of sepsis-associated brain dysfunction(SABD) with worse outcomes? while is still unknown. We aimed to investigate the neurologic features and risk factors of SABD with worse outcomes in ICU.Methods: A retrospective cohort study linked data from the Affiliated Shuyang Hospital of Xuzhou Medical University (Jan 2018–Nov 2019), China. Acute critically ill patients who were undergone a brain-chest-abdomen computed tomograph (CT) scanning before arriving at the ICU were selected as an eligibility criteria. The primary outcome measure was the neurologic feature and the mortality at the first 30 days. Outcomes were compared between patients who were survivors and those who were not.Findings: A total of 214 critically ill patients with sepsis in ICU was diagnosed by a systemic CT screening and a Sequential [sepsis- related]Organ Failure Assessment (SOFA) criteria. Of them, 202 SABD (94.4%,202/214) was identified according to sepsis-3 criteria for the brain and the findings of CT screening. 135 was male (66.8 %) with mean age 67 years. In these SABD with worse outcomes, initial delirium (50.0%) was an early neurologic feature, followed by acute stupor or coma (42.6%). While, the most common infection was community-acquired pneumonia (93.9%, 108/115). However, all SABD with nonsurvivors was finally developed to coma/deep coma and with brain edema (97.4%) confirmed by CT. By multifactors analysis, severe inflammatory storm (OR, 7.2; 95% CI, 2.58- 24.94), higher SOFA scores (OR, 1.8; 95% CI, 1.5-3.6), and elevated CRP level (OR, 1.0; 95% CI, 1.26-1.96) were the risk factors for death in SABD. The fatality of SABD with worse outcome was 56.9% at initial 30 days.Interpretation: The neurologic features of SABD with worse outcomes in ICU are initial delirium and acute stupor/coma, and followed by eventually coma/deep coma, which is related to the severe inflammatory storm, higher SOFA score, and elevated CPR level.Funding Information: National Clinical Key Specialty Construction Project.Declaration of Interests: All authors declare that no conflicts of interest exist.Ethics Approval Statement: The study was approved by the ethical committee on clinical research of the Affiliated Shuyang Hospital of Xuzhou Medical University, and written informed consent was obtained from parents or legal guardian.