The association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective study
Abstract Background 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 preva...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-023-04475-w |
| _version_ | 1797827524868177920 |
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| author | Lorenzo Ferlini Christelle Maenhout Ilaria Alice Crippa Armin Alvaro Quispe-Cornejo Jacques Creteur Fabio Silvio Taccone Nicolas Gaspard |
| author_facet | Lorenzo Ferlini Christelle Maenhout Ilaria Alice Crippa Armin Alvaro Quispe-Cornejo Jacques Creteur Fabio Silvio Taccone Nicolas Gaspard |
| author_sort | Lorenzo Ferlini |
| collection | DOAJ |
| description | Abstract Background 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). Methods 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 χ 2 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. Results 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). Conclusion Our findings suggest that PDs and PDs burden are associated with SAE and might affect outcome in septic patients. |
| first_indexed | 2024-04-09T12:49:42Z |
| format | Article |
| id | doaj.art-a94feb9f09f34d618bb82df6d04c6c01 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-09T12:49:42Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-a94feb9f09f34d618bb82df6d04c6c012023-05-14T11:18:30ZengBMCCritical Care1364-85352023-05-0127111110.1186/s13054-023-04475-wThe association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective studyLorenzo Ferlini0Christelle Maenhout1Ilaria Alice Crippa2Armin Alvaro Quispe-Cornejo3Jacques Creteur4Fabio Silvio Taccone5Nicolas Gaspard6Department of Neurology, Erasme Hospital, Université Libre de BruxellesDepartment of Neurology, Erasme Hospital, Université Libre de BruxellesDepartment of Anesthesiology and Intensive Care, Policlinico San Marco, Gruppo San DonatoDepartment of Intensive Care, Erasme Hospital, Université Libre de BruxellesDepartment of Intensive Care, Erasme Hospital, Université Libre de BruxellesDepartment of Intensive Care, Erasme Hospital, Université Libre de BruxellesDepartment of Neurology, Erasme Hospital, Université Libre de BruxellesAbstract Background 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). Methods 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 χ 2 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. Results 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). Conclusion Our findings suggest that PDs and PDs burden are associated with SAE and might affect outcome in septic patients.https://doi.org/10.1186/s13054-023-04475-wSepsisBrain dysfunctionPeriodic dischargesOutcome and EEG |
| spellingShingle | Lorenzo Ferlini Christelle Maenhout Ilaria Alice Crippa Armin Alvaro Quispe-Cornejo Jacques Creteur Fabio Silvio Taccone Nicolas Gaspard The association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective study Critical Care Sepsis Brain dysfunction Periodic discharges Outcome and EEG |
| title | The association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective study |
| title_full | The association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective study |
| title_fullStr | The association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective study |
| title_full_unstemmed | The association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective study |
| title_short | The association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective study |
| title_sort | association between the presence and burden of periodic discharges and outcome in septic patients an observational prospective study |
| topic | Sepsis Brain dysfunction Periodic discharges Outcome and EEG |
| url | https://doi.org/10.1186/s13054-023-04475-w |
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