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Sepsis-associated brain dysfunction in critically ill patients
Critical Care volume 17, Article number: P29 (2013)
Delirium is a common occurrence in critically ill patients and is associated with an increase in morbidity and mortality . Some evidence suggests that septic patients with delirium may differ from a general critically ill population. In a subgroup analysis of the MENDS study, a benefit of dexmedetomidine sedation over lorazepam was only evident in septic patients . The aim of our study was investigate the relationship between systemic inflammation and the development of delirium in septic and nonseptic critically ill patients.
Materials and methods
We performed a cohort study in a 20-bed mixed ICU that included consecutive patients admitted for more than 24 hours. Delirium was diagnosed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Coma was defined as a Richmond Agitation Sedation Scale (RASS) score of -4 or -5. Blood samples were collected within 12 hours of enrollment for determination of TNFα, soluble TNF receptor (STNFR)-1 and STNFR-2, IL-1β, IL-6, IL-10 and adiponectin.
Seventy-eight patients were included in the study: 26 nonseptic/nondelirium (control), 13 nonseptic/delirium (delirium), 21 septic/nondelirium (septic) and 18 septic/delirium (sepsis-associated delirium (SAD)). From all analyzed biomarkers only STNFR1, STNFR2 and adiponectin were independently associated with delirium occurrence, but none of these biomarkers had a significant interaction with sepsis. In contrast, there was significantly interaction between sepsis and IL-1β suggesting that this cytokine is differently modulated when comparing septic and nonseptic patients with delirium.
The association between IL-1β and delirium is different in septic versus nonseptic patients, suggesting that mechanisms which drive SAD may differ from that of nonseptic ICU delirium.
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS: Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004, 291: 1753-1762. 10.1001/jama.291.14.1753
Pandharipande PP, Sanders RD, Girard TD, McGrane S, Thompson JL, Shintani AK, Herr DL, Maze M, Ely EW, MENDS investigators: Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial. Crit Care 2010, 14: R38. 10.1186/cc8916
This work was funded by the NENASC project (PRONEX program CNPq/FAPESC); INCT-TM; PROCAD Sepse - CAPES and FAPEMIG.
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Tomasi, C.D., Vuolo, F., Constantino, L.d.S. et al. Sepsis-associated brain dysfunction in critically ill patients. Crit Care 17 (Suppl 4), P29 (2013). https://doi.org/10.1186/cc12929
- Systemic Inflammation
- Septic Patient
- Brain Dysfunction
- Confusion Assessment