Diagnosis of sepsis associated encephalopathy: a retrospective analysis of 6 patients

Abstract

Objective To investigate whether the presence of infection in a case series with coma would predict sepsis associated encephalopathy(SAE). Methods From Jan 2013 to Oct 2014, we used the criteria of systemic inflammatory response syndrome (SIRS) positive sepsis with encephalopathy and retrospective diagnosed a comatose case series with infection and from a tertiary teaching hospital intensive care unit (ICU). Results Among 6 comatose patients with evidence of infection, 3 cases were secondary infection after hemorrhagic stroke, 1 case was secondary infection after trauma, and the other 2 cases were primary infection.All patients met the diagnosis of SIRS-positive sepsis with encephalopathy.Among them, the presence of SIRS 3 criteria was in 2 cases, four criteria in 4 cases.All patients with severe brain failure (100%), in addition to 5 cases with acute respiratory failure caused by lung injury, one case with acute liver failure.Brain imaging confirmed that the delayed vasogenic edema was in two cases(33.3%), the cerebral ischemic lesions in four cases(66.7%). The ischemic lesion included 1 patient with minor infarcts and 1 case with mild white matter lesions, and with a good prognosis.The other two ischemic cases included multifocal leukoencephalopathy with central pontine myelinolysis in 1 case and extensive white matter lesions in 1 case, eventually with a poor prognosis. Conclusion SAE is a common critically illness, the use of the new classification criteria of sepsis is helpful in the diagnosis of sepsis associated encephalopathy. Key words: Sepsis; Sepsis associated encephalopathy; Coma; Systemic inflammatory response syndrome; Organ failure; Imaging