The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit

被引：6

作者：

Crippa, Ilaria A. ^{[1
]}

Taccone, Fabio S. ^{[1
]}

Wittebole, Xavier ^{[2
]}

Martin-Loeches, Ignacio ^{[3
,4
]}

Schroeder, Mary E. ^{[5
]}

Francois, Bruno ^{[6
,7
,8
]}

Kotfis, Katarzyna ^{[9
]}

Namendys-Silva, Silvio A. ^{[10
,11
]}

Forceville, Xavier ^{[12
,13
]}

Sole-Violan, Jordi ^{[14
]}

Fontes, Luis E. ^{[15
]}

Vincent, Jean-Louis ^{[1
]}

机构：

[1] Univ Libre Bruxelles, Erasme Hosp, Dept Intens Care, B-1070 Brussels, Belgium

[2] UCLouvain, Clin Univ St Luc, Dept Crit Care, B-1200 Brussels, Belgium

[3] St Jamess Univ Hosp Dublin, Multidisciplinary Intens Care Res Org MICRO, Trinity Ctr Hlth Sci, Wellcome Trust,HRB Clin Res,Dept Clin Med, Dublin D08 NHY1, Ireland

[4] Univ Barcelona, Ciberes, IDIBAPS, Hosp Clin, Barcelona 08036, Spain

[5] Med Coll Wisconsin, Froedtert Hosp, Div Trauma & Crit Care Surg, Milwaukee, WI 53226 USA

[6] Dupuytren Univ Hosp, Intens Care Unit, F-87000 Limoges, France

[7] Dupuytren Univ Hosp, INSERM, CIC 1435, F-87000 Limoges, France

[8] Dupuytren Univ Hosp, UMR 1092, F-87000 Limoges, France

[9] Pomeranian Med Univ, Dept Anesthesiol Intens Therapy & Acute Intoxicat, PL-70111 Szczecin, Poland

[10] Inst Nacl Cancerol, Dept Crit Care Med, Mexico City 14080, DF, Mexico

[11] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Div Pulm Anesthesia & Crit Care Med, Mexico City 14080, DF, Mexico

[12] Hop St Faron, Great Hosp East Francilien, Medicosurg Intens Care Unit, Meaux Site, F-77100 Meaux, Seine & Marne, France

[13] Univ Rennes, CHU Rennes, INSERM, CIC 1414,Clin Invest Ctr, F-35033 Rennes, France

[14] Univ Hosp GC Dr Negrin, Intens Care Unit, Las Palmas Gran Canaria 35010, Gran Canaria, Spain

[15] Fac Med Petropolis, Dept Med Baseada Evidencias Med Intens Urgencia &, BR-25680120 Petropolis, RJ, Brazil

来源：

BRAIN SCIENCES | 2021年 / 11卷 / 05期

关键词：

brain function; Glasgow Coma Scale; ICU; outcome; INTENSIVE-CARE; SEPTIC ENCEPHALOPATHY; ORGAN DYSFUNCTION; MORTALITY; DELIRIUM; SCORE; TERM;

D O I：

10.3390/brainsci11050530

中图分类号：

Q189 [神经科学];

学科分类号：

071006 ;

摘要：

Brain dysfunction is associated with poor outcome in critically ill patients. In a post hoc analysis of the Intensive Care over Nations (ICON) database, we investigated the effect of brain dysfunction on hospital mortality in critically ill patients. Brain failure was defined as a neurological sequential organ failure assessment (nSOFA) score of 3-4, based on the assumed Glasgow Coma Scale (GCS) score. Multivariable analyses were performed to assess the independent roles of nSOFA and change in nSOFA from admission to day 3 (Delta nSOFA) for predicting hospital mortality. Data from 7192 (2096 septic and 5096 non-septic) patients were analyzed. Septic patients were more likely than non-septic patients to have brain failure on admission (434/2095 (21%) vs. 617/4665 (13%), p < 0.001) and during the ICU stay (625/2063 (30%) vs. 736/4665 (16%), p < 0.001). The presence of sepsis (RR 1.66 (1.31-2.09)), brain failure (RR 4.85 (3.33-7.07)), and both together (RR 5.61 (3.93-8.00)) were associated with an increased risk of in-hospital death, but nSOFA was not. In the 3280 (46%) patients in whom Delta nSOFA was available, sepsis (RR 2.42 (1.62-3.60)), brain function deterioration (RR 6.97 (3.71-13.08)), and the two together (RR 10.24 (5.93-17.67)) were associated with an increased risk of in-hospital death, whereas improvement in brain function was not.

引用

页数：10

共 22 条

[1] Intensive Care Delirium Screening Checklist: evaluation of a new screening tool [J].

Bergeron, N ;

Dubois, MJ ;

Dumont, M ;

Dial, S ;

Skrobik, Y .

INTENSIVE CARE MEDICINE, 2001, 27 (05) :859-864

[2] Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study [J].

Blanco, Jesus ;

Muriel-Bombin, Arturo ;

Sagredo, Victor ;

Taboada, Francisco ;

Gandia, Francisco ;

Tamayo, Luis ;

Collado, Javier ;

Garcia-Labattut, Angel ;

Carriedo, Demetrio ;

Valledor, Manuel ;

De Frutos, Martin ;

Lopez, Maria-Jesus ;

Caballero, Ana ;

Guerra, Jose ;

Alvarez, Braulio ;

Mayo, Agustin ;

Villar, Jesus .

CRITICAL CARE, 2008, 12 (06)

[3] NEUROLOGIC COMPLICATIONS OF CRITICAL MEDICAL ILLNESSES [J].

BLECK, TP ;

SMITH, MC ;

PIERRELOUIS, SJC ;

JARES, JJ ;

MURRAY, J ;

HANSEN, CA .

CRITICAL CARE MEDICINE, 1993, 21 (01) :98-103

[4] Managing the nervous system effects of sepsis [J].

Bolton, Charles F. ;

Young, G. Bryan .

CHEST, 2007, 131 (05) :1273-1274

[5] The spectrum of septic encephalopathy - Definitions, etiologies, and mortalities [J].

Eidelman, LA ;

Putterman, D ;

Putterman, C ;

Sprung, CL .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 275 (06) :470-473

[6] Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [J].

Ely, EW ;

Margolin, R ;

Francis, J ;

May, L ;

Truman, B ;

Dittus, R ;

Speroff, T ;

Gautam, S ;

Bernard, GR ;

Inouye, SK .

CRITICAL CARE MEDICINE, 2001, 29 (07) :1370-1379

[7] Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit [J].

Ely, EW ;

Shintani, A ;

Truman, B ;

Speroff, T ;

Gordon, SM ;

Harrell, FE ;

Inouye, SK ;

Bernard, GR ;

Dittus, RS .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 291 (14) :1753-1762

[8] Serial evaluation of the SOFA score to predict outcome in critically ill patients [J].

Ferreira, FL ;

Bota, DP ;

Bross, A ;

Mélot, C ;

Vincent, JL .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 286 (14) :1754-1758

[9] Sepsis-associated encephalopathy [J].

Gofton, Teneille E. ;

Young, G. Bryan .

NATURE REVIEWS NEUROLOGY, 2012, 8 (10) :557-566

[10]

Gorji Mohammad Ali Heidari, 2015, Int J Appl Basic Med Res, V5, P92, DOI 10.4103/2229-516X.157152

← 1 2 3 →