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Pohlan J, Nawabi J, Witham D, Schroth L, Krause F, Schulze J, Gelen S, Ahlborn R, Rubarth K, Dewey M. Cerebrovascular Events in Suspected Sepsis: Retrospective Prevalence Study in Critically Ill Patients Undergoing Full-Body Computed Tomography. Front Neurol 2022; 13:811022. [PMID: 35614926 PMCID: PMC9125158 DOI: 10.3389/fneur.2022.811022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aimed at retrospectively evaluating full-body computed tomography (CT) examinations for the prevalence of cerebrovascular events in patients with suspected sepsis treated in the intensive care unit (ICU). Methods All full-body CT examinations, i.e., both cranial CT (cCT) and body CT including chest, abdomen and pelvis, for focus search in septic patients over a 12-months period were identified from three ICUs, using full-text search. From this retrospective cohort, we fully analyzed 278 cCT examinations for the occurrence of acute cerebral findings. All acute cerebrovascular events were independently reviewed by two blinded readers. Clinical and laboratory findings were extracted. The data were statistically analyzed using contingency tests. Results In our population of patients with suspected sepsis, 10.8% (n = 30/278) were identified to have major cerebral events, including 7.2% (n = 20/278) major cerebrovascular events and 4.3% (n = 12/278) generalized parenchymal damage. 13.4% (n = 22/163) of patients with a severe coma as compared with non-severe coma, 4.4% (n = 3/68), showed a major cerebral event (p = 0.04). Patients referred from the cardiology/nephrology ICU ward showed major cerebral events in 16.3% (n = 22/135), as compared with 4.9% (n = 3/61) in patients from pulmonary ICU and 6.1% (n = 5/82) major cerebral events with surgical referral (p = 0.02). Conclusion Our study provides further evidence that septic patients may suffer from cerebral events with relevance to their prognosis. Severe coma and the referring ward were associated with acute cerebral conditions. Full-body CT has the advantage of both detecting of septic foci and possibly identifying ischemic or hemorrhagic stroke in this vulnerable patient population.
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Affiliation(s)
- Julian Pohlan
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
- *Correspondence: Julian Pohlan
| | - Jawed Nawabi
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
| | - Denis Witham
- Department of Cardiology With Intensive Care, Charité – Universitätsmedizin Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Luna Schroth
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Finn Krause
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan Schulze
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Simon Gelen
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Ahlborn
- Department of Information Technology, Charité – Universitätsmedizin Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Rubarth
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Ye-Ting Z, Dao-Ming T. Systemic Inflammatory Response Syndrome (SIRS) and the Pattern and Risk of Sepsis Following Gastrointestinal Perforation. Med Sci Monit 2018; 24:3888-3894. [PMID: 29884777 PMCID: PMC6024714 DOI: 10.12659/msm.907922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Systemic inflammatory response syndrome (SIRS) is characterized by systemic inflammation and tissue injury. Secondary sepsis is a common critical illness associated with poor clinical outcome. The aim of this study was to investigate the risk of SIRS-positive and SIRS-negative sepsis following gastrointestinal (GI) perforation. Material/Methods A retrospective study included 51 patients with GI perforation who had clinical evidence of sepsis, with or without SIRS. Clinical outcome was assessed at day 30 using the Glasgow Outcome Scale (GOS) (score, 1–5) and the sequential organ failure assessment (SOFA) (score, 1–6) to determine organ function. Results Fifty-one patients were included in the study (median age, 74 years; 37 male patients); 20 patients (39.2%) developed secondary sepsis; 16 patients (80%) had SIRS-negative sepsis; four patients had SIRS-positive sepsis. An increased SOFA score was a significant independent predictor of GI perforation with sepsis (5.4±3.1 vs. 1.5±2.8) (P<0.0001). Patients with GI perforation with SIRS-negative sepsis had a significantly less favorable outcome (5/16 vs. 2/35) (P=0.03). The risk of SIRS-negative sepsis following GI perforation was 39.2%, and the risk of mortality for SIRS-negative sepsis was 31.3%. In the Cox regression analysis, septic shock and septic encephalopathy were associated with a worse clinical outcome. Conclusions The findings of this study support the recognition of SIRS-negative sepsis following GI perforation as an important condition to recognize clinically, given its association with increased patient morbidity and mortality.
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Affiliation(s)
- Zhou Ye-Ting
- Department of General Surgery, Affiliated Shuyang Peoples' Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
| | - Tong Dao-Ming
- Department of Neurology, Affiliated Shuyang Peoples' Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
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