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Critical Care

Volume 17 Supplement 4

Sepsis 2013

Open Access

Sepsis-associated brain dysfunction in critically ill patients

  • Cristiane Damiani Tomasi1,
  • Franciele Vuolo1,
  • Larissa de Souza Constantino1,
  • Dhébora Mozena Dall'Igna1,
  • Eduardo Mazon1,
  • Renato Mafioleti1,
  • João Quevedo1,
  • Cristiane Ritterl1,
  • Antonio Teixeira2 and
  • Felipe Dal-Pizzol1
Critical Care201317(Suppl 4):P29

Published: 5 November 2013


Systemic InflammationSeptic PatientDexmedetomidineBrain DysfunctionConfusion Assessment


Delirium is a common occurrence in critically ill patients and is associated with an increase in morbidity and mortality [1]. 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 [2]. 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.



This work was funded by the NENASC project (PRONEX program CNPq/FAPESC); INCT-TM; PROCAD Sepse - CAPES and FAPEMIG.

Authors’ Affiliations

Laboratório de Fisiopatologia Experimental, Universidade do Extremo Sul Catarinense,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Criciúma, Brazil
Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas da UFMG, Belo Horizonte, Brazil


  1. 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.291.14.1753View ArticlePubMedGoogle Scholar
  2. 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/cc8916PubMed CentralView ArticlePubMedGoogle Scholar


© Tomasi et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.