背景:脓毒症相关性脑病(SAE)在脓毒症患者中常见。脑电图(EEG)对检测早期癫痫异常非常敏感,如癫痫发作和定期放电(PD),并量化它们的持续时间(所谓的负担)。然而,这些脑电图异常在脓毒症患者中的患病率,以及它们对发病率和死亡率的影响,还不清楚。这项研究的目的是评估是否存在电描记图异常(即没有反应性,癫痫发作和PDs的存在和负担)与脓毒症患者的功能结局和死亡率相关,以及这些异常是否与脓毒症相关性脑病(SAE)相关.
方法:我们前瞻性地纳入了脓毒症患者,没有已知的慢性或急性颅内疾病或预先存在的急性脑病,要求入住三级学术中心的ICU。纳入后72小时内开始连续脑电图监测,并进行长达7天。由训练有素的神经心理学家每天两次对意识和谵妄进行全面评估。主要终点是不利的功能结局(UO,定义为格拉斯哥结果量表-扩展-GOSE-评分<5),出院时收集的死亡率和次要终点是PDs与SAE的关联。Mann-Whitney,Fisher精确检验和χ2检验用于评估组间变量的差异,视情况而定。住院死亡率的多变量logistic回归分析,功能结果,进行SAE或PD作为因变量。
结果:我们纳入了92例患者。没有发现癫痫发作。近25%的患者患有PD。PD和PD负担的存在与单变量的UO相关(n=15[41%],分别为p=0.005和p=0.008)和,对于PD存在,在校正疾病严重程度后的多变量分析中也是如此(OR3.82,IC95%[1.27-11.49],p=0.02)。PDs负担与GOSE呈负相关(斯皮尔曼系数ρ=-0.2,p=0.047)。PDs的存在也与SAE独立相关(OR8.98[1.11-72.8],p=0.04)。在大多数患者中观察到反应性,并与结局相关(功能结局和死亡率p=0.044)。
结论:我们的研究结果表明,PDs和PDs负荷与SAE相关,并可能影响脓毒症患者的预后。
Sepsis-associated encephalopathy (SAE) is frequent in septic patients. Electroencephalography (EEG) is very sensitive to detect early epileptic abnormalities, such as seizures and periodic discharges (PDs), and to quantify their duration (the so-called burden). However, the prevalence of these EEG abnormalities in septic patients, as well as their effect on morbidity and mortality, are still unclear. The aims of this study were to assess whether the presence of electrographic abnormalities (i.e. the absence of reactivity, the presence and burden of seizures and PDs) was associated with functional outcome and mortality in septic patients and whether these abnormalities were associated with sepsis-associated encephalopathy (SAE).
We prospectively included septic patients, without known chronic or acute intracranial disease or pre-existing acute encephalopathy, requiring ICU admission in a tertiary academic centre. Continuous EEG monitoring was started within 72 h after inclusion and performed for up to 7 days. A comprehensive assessment of consciousness and delirium was performed twice daily by a trained neuropsychologist. Primary endpoints were unfavourable functional outcome (UO, defined as a Glasgow Outcome Scale-Extended-GOSE-score < 5), and mortality collected at hospital discharge and secondary endpoint was the association of PDs with SAE. Mann-Whitney, Fisher\'s exact and χ2 tests were used to assess differences in variables between groups, as appropriate. Multivariable logistic regression analysis with in-hospital mortality, functional outcome, SAE or PDs as the dependent variables were performed.
We included 92 patients. No seizures were identified. Nearly 25% of patients had PDs. The presence of PDs and PDs burden was associated with UO in univariate (n = 15 [41%], p = 0.005 and p = 0.008, respectively) and, for PDs presence, also in multivariate analysis after correcting for disease severity (OR 3.82, IC 95% [1.27-11.49], p = 0.02). The PDs burden negatively correlated with GOSE (Spearman\'s coefficient ρ = - 0.2, p = 0.047). The presence of PDs was also independently associated with SAE (OR 8.98 [1.11-72.8], p = 0.04). Reactivity was observed in the majority of patients and was associated with outcomes (p = 0.044 for both functional outcome and mortality).
Our findings suggest that PDs and PDs burden are associated with SAE and might affect outcome in septic patients.