Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry
Abstract Background Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and ou...
| 主要な著者: | , , , , , , , , , |
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| フォーマット: | 論文 |
| 言語: | English |
| 出版事項: |
BMC
2021-11-01
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| シリーズ: | Critical Care |
| 主題: | |
| オンライン･アクセス: | https://doi.org/10.1186/s13054-021-03828-7 |
| _version_ | 1829489329673601024 |
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| author | Ryuta Nakae Tetsuro Sekine Takashi Tagami Yasuo Murai Eigo Kodani Geoffrey Warnock Hidetaka Sato Akio Morita Hiroyuki Yokota Shoji Yokobori |
| author_facet | Ryuta Nakae Tetsuro Sekine Takashi Tagami Yasuo Murai Eigo Kodani Geoffrey Warnock Hidetaka Sato Akio Morita Hiroyuki Yokota Shoji Yokobori |
| author_sort | Ryuta Nakae |
| collection | DOAJ |
| description | Abstract Background Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and outcomes. Methods Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included (n = 48). The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the “brain atrophy group (n = 42)”, and those with ≥ 0% were defined as the “no brain atrophy group (n = 6).” Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups. Results Analysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. second CT scan: 1.002 ± 0.121 L, t (41) = 9.436, p < 0.001). The mean percentage change in brain volume between CT scans in the brain atrophy group was –3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm3. The proportion of cases on mechanical ventilation (95.2% vs. 66.7%; p = 0.02) and median time on mechanical ventilation (28 [IQR 15–57] days vs. 15 [IQR 0–25] days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group. Conclusions Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation. |
| first_indexed | 2024-12-15T00:05:49Z |
| format | Article |
| id | doaj.art-037e73ce67cc4adb83e28bc20c58ea4a |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-15T00:05:49Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-037e73ce67cc4adb83e28bc20c58ea4a2022-12-21T22:42:44ZengBMCCritical Care1364-85352021-11-012511910.1186/s13054-021-03828-7Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetryRyuta Nakae0Tetsuro Sekine1Takashi Tagami2Yasuo Murai3Eigo Kodani4Geoffrey Warnock5Hidetaka Sato6Akio Morita7Hiroyuki Yokota8Shoji Yokobori9Department of Emergency and Critical Care Medicine, Nippon Medical School HospitalDepartment of Radiology, Nippon Medical School Musashi Kosugi HospitalDepartment of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi HospitalDepartment of Neurosurgery, Nippon Medical School HospitalDepartment of Radiology, Nippon Medical School Musashi Kosugi HospitalPMOD Technologies Ltd.Department of Emergency and Critical Care Medicine, Nippon Medical School HospitalDepartment of Neurosurgery, Nippon Medical School HospitalGraduate School of Medical and Health Science, Nippon Sport Science UniversityDepartment of Emergency and Critical Care Medicine, Nippon Medical School HospitalAbstract Background Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and outcomes. Methods Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included (n = 48). The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the “brain atrophy group (n = 42)”, and those with ≥ 0% were defined as the “no brain atrophy group (n = 6).” Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups. Results Analysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. second CT scan: 1.002 ± 0.121 L, t (41) = 9.436, p < 0.001). The mean percentage change in brain volume between CT scans in the brain atrophy group was –3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm3. The proportion of cases on mechanical ventilation (95.2% vs. 66.7%; p = 0.02) and median time on mechanical ventilation (28 [IQR 15–57] days vs. 15 [IQR 0–25] days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group. Conclusions Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation.https://doi.org/10.1186/s13054-021-03828-7BrainAtrophySepsisMechanical ventilationCritical care outcomes |
| spellingShingle | Ryuta Nakae Tetsuro Sekine Takashi Tagami Yasuo Murai Eigo Kodani Geoffrey Warnock Hidetaka Sato Akio Morita Hiroyuki Yokota Shoji Yokobori Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry Critical Care Brain Atrophy Sepsis Mechanical ventilation Critical care outcomes |
| title | Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry |
| title_full | Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry |
| title_fullStr | Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry |
| title_full_unstemmed | Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry |
| title_short | Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry |
| title_sort | rapidly progressive brain atrophy in septic icu patients a retrospective descriptive study using semiautomatic ct volumetry |
| topic | Brain Atrophy Sepsis Mechanical ventilation Critical care outcomes |
| url | https://doi.org/10.1186/s13054-021-03828-7 |
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