Abstract
BackgroundSepsis-associated encephalopathy (SAE) is related to increased short-term mortality in patients with sepsis. We aim to establish a user-friendly nomogram for individual prediction of 30-day risk of mortality in patients with SAE.MethodsData were retrospectively retrieved from the Medical Information Mart for Intensive Care (MIMIC III) open source clinical database. SAE was defined by Glasgow Coma Score (GCS) < 15 or delirium at the presence of sepsis. Prediction model with a nomogram was constructed in the training set by logistic regression analysis and then undergone internal validation and sensitivity analysis.ResultsSAE accounted for about 50% in patients with sepsis and was independently associated with the 30-day mortality of sepsis. Variables eligible for the nomogram included patient’s age and clinical parameters on the first day of ICU admission including the GCS score, lactate, bilirubin, red blood cell distribution width (RDW), mean value of respiratory rate and temperature, and the use of vasopressor. Compared with Sequential Organ Failure Assessment (SOFA) and Logistic Organ Dysfunction System (LODS), the nomogram exhibited better discrimination with an area under the receiver operating characteristic curve (AUROC) of 0.763 (95%CI 0.736–0.791, p < 0.001) and 0.753 (95%CI 0.713–0.794, p < 0.001) in the training and validation sets, respectively. The calibration plot revealed an adequate fit of the nomogram for predicting the risk of 30-day mortality in both sets. Regarding to clinical usefulness, the DCA of the nomogram exhibited greater net benefit than SOFA and LODS in both of the training and validation sets. Besides, the nomogram exhibited acceptable discrimination, calibration, and clinical usefulness in sensitivity analysis.ConclusionsSAE is related to increased 30-day mortality of patients with sepsis. The nomogram presents excellent performance in predicting 30-day risk of mortality in SAE patients, which can be used to evaluate the prognosis of patients with SAE and may be more beneficial once specific treatments towards SAE are developed.
Highlights
Sepsis-associated encephalopathy (SAE) is the dysfunction of brain that develops during the process of sepsis without evidence of the central nervous system (CNS) infection
The main objective of the present study by a large clinical database is to evaluate the impact of SAE on the 30-day mortality of patients with sepsis and develop a predictive nomogram to individually predict the probability of 30-day death in SAE patients
Patients with SAE were more likely to admit into the medical intensive care unit (MICU) and suffer from hypertension, anemias, and history of neurological diseases, which mainly included Parkinson’s disease, Huntington’s chorea, and leukodystrophy
Summary
Sepsis-associated encephalopathy (SAE) is the dysfunction of brain that develops during the process of sepsis without evidence of the central nervous system (CNS) infection. Similar conclusions were drew from another high-quality study performed by Sonneville et al, which showed decreased 30-day survival rate from 67% when GCS is 15 to 32% when GCS is between 3 and 8, and even mild change in consciousness (defined by GCS of 13–14) is an independent risk factor for the 30-day mortality with an hazard rate (HR) of 1.38 after adjusting for confounding factors [5] Except for these two high quality studies, several other researches reported that SAE was responsible for increased short-term mortality, prolonged hospitalization time, or overmuch assumption of medical resources [6, 7]. We aim to establish a user-friendly nomogram for individual prediction of 30-day risk of mortality in patients with SAE
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