Abstract
Sepsis-associated encephalopathy (SAE) is a common complication of sepsis. It is imperative to recognize, diagnose, and effectively manage SAE at the early stages. The aim of this study was to evaluate the potential of using the serum tau protein level in the diagnosis of SAE and the prediction of SAE outcomes. This was a retrospective and observational study. The patients included in this study were diagnosed with severe sepsis or septic shock. The serum tau protein level was measured using a commercial enzyme-linked immunosorbent assay. The association between the level of serum tau protein and SAE was assessed by multiple logistic regression analysis. One hundred nine patients with severe sepsis were enrolled during a period of two years. Of the 109 enrolled patients, 27 developed SAE. The serum tau protein level was significantly higher in the patients with SAE than that of the non-SAE group. The serum tau protein level and the sequential organ failure assessment (SOFA) score were independent factors that were associated with SAE. The combined use of the serum tau protein level with the SOFA score improved the accuracy in distinguishing SAE from non-SAE patients. A cutoff value serum tau protein level of 75.92 pg/mL had 81.1% sensitivity and 86.1% specificity in predicting the 28-day mortality in patients with severe sepsis. We identified a close association between the serum tau protein level with the appearance of SAE in patients with severe sepsis. The serum tau protein level can be useful in the prediction of poor outcomes in patients with sepsis.
Highlights
Sepsis is a severe syndrome that can involve the dysfunction and failure of multiple organs, including acute brain dysfunction
Patients. is retrospective and observational study was conducted at the First Hospital of Jilin University. e patients included in this study were diagnosed with severe sepsis or septic shock in the emergency intensive care unit (ICU) between January 2016 and December 2017. e study protocol was approved by the Ethics Committee of the First Hospital, Jilin University
E Receiver operating characteristics (ROC) curve determined that a serum tau protein level >71.96 pg/mL (AUC: 0.770, 95% confidence interval (CI): 0.671–0.869) can predict Sepsis-associated encephalopathy (SAE) with 70.4% sensitivity and 72.0% specificity
Summary
Sepsis is a severe syndrome that can involve the dysfunction and failure of multiple organs, including acute brain dysfunction. SAE is reversible, if no permanent brain damage occurs, survivors may suffer from permanent or irreversible cognitive impairment, leading to behavioral alteration and deteriorated life quality or early death [2]. There is a notable lack of specific and sensitive biomarkers for the diagnosis of SAE. Because SAE pathophysiology remains poorly understood [4], exclusion methodology is used as a major clinical SAE diagnosis algorithm, in combination with case history, the state of consciousness, alterations in cognitive function, the Glasgow Coma Scale (GCS) score, neurological imaging examination, electroencephalography (EEG), and pathological findings. There are no reliable biomarkers for the prognosis of sepsis, during the early stages of the disease. The clinical value of several biomarkers in the prediction of SAE outcomes has been evaluated, including serum S100β [5], neuron-specific
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