Risk Factors And Prognosis Of Septic Encephalopathy Patients

Objective:To investigate the incidence and significants of the prognosis of sepsis encephalopathyMethods:1.Collected 109 cases from emergency medical center of Tianjin Medical University General hospital between 2008 July and 2010 May.2.According to the sepsis diagnosis criteria which provided by Society of Critical Care Medicine, excluded the patients with hypotension, hypoglycemia, liver failure, poisoning that affect the symptomatic diagnosis of central nervous system, the patients who correspond with the opinion of Papadopoulos MC with alteration of attention, memory, orientation were included by our study. Meanwhile, the sepsis group were divided into two subgroups (septic encephalopathy and septic of no encephalopathy) according to the criteria of septic encephalopathy. Also the sepsis group were divided into two subgroups(survival group and death group) according to 28-day mortality.3.Collected the cases of patients'age, gender, the site of infection, pathogenic bacteria, whether had the history of smoking, diabetes mellitus, hyperlipidemia, coronary artery disease. Monitored the dynamic changes of body temperature, White blood cell(WBC), Platelet(PLT), Albumin(Alb), Creatinine(Cr), Kalium(K), Natrium(Na), C-reactive protein(CRP), Erythrocyte sedimentation rate(ESR), D-Dimer on the 1st and 3rd day after admission. Calculated the clearance of lactic acid within six hours. Followed the 28-day motability and recorded the acute physiology and chronic health evaluation(APACHE II), sequential organ failure assessment(SOFA) and Glasgow coma scale(GCS).4.We choose the immunopotentiation method to monitor D-Dimer, used the kids provided by company of Dade Behring in America and the blood coagulation analyzer of Sysmex CA-7000.5.The statistical analysis was performed with SPSS17.0 software. Measurement date were expressed by (χ±s),More than two mean group were analyzed by variance, Numeration data were analyzed byχ2.The diagnostic accuracy of related indicators was evaluated by ROC curves. The correlation analysis were performed by Logistic regression analysis. Select P<0.05 as statistical difference.Result:1.The incidence of septic encephalopathy was 51%.2.The site of infection had no significant different between septic encephalopathy and sepsis with no encephalopathy.3.In septic encephalopathy group, the detectable rate of Gram-positive bacteria was 16% and Gram-negative bacteria was 42%, which were higher than group without encephalopathy. In septic encephalopathy group, the detectable rate of fungus was 7% and plural pathogenic was 9%, and in group without encephalopathy,the detectable rate of fungus was 11% and plural pathogenic was 23%. There had no significant different in fungal and plural pathogenic infection between septic encephalopathy and sepsis with no encephalopathy.4.Seiptic encephalopathy patients with diabetes mellitus, coagulation disorder and the APACHE II≥20 score were higher than that of no-encephalopathy(P=0.023, P=0.008, P=0.011)5.The morbidity of septic encephalopathy was 32.14%, which was higher than sepsis of no encephalopathy (11.32%).6.SOFA and D-Dimer positively correlated with the morbidity of septic encephalopathy. GCS and the clearance of lactic acid within six hours negativity correlated with the morbidity of septic encephalopathy.7.The AUC of SOFA,D-Dimer,the clearance of lactic acid within six hours and GCS were 0.793,0.893,0.882,0.724, which had significant differents(P< 0.05).Conclusions:1.Septic encephalopathy was one of complication of sepsis, and it had the characters of high incidence.2.Septic patients infected by Gram-positive bacteria and Gram-negative bacteria were more susceptible to complicate septic encephalopathy than patients with fungi infaction.3.Septic patients with diabetes mellitus, coagulation disorder and the APACHE II≥20 score were more susceptible to complicate septic encephalopathy.4.The morbidity of septic encephalopathy was higher than sepsis of no encephalopathy.5.Calculating the clearance of lactic acid within six hours and monitoring the dynamic changes of D-Dimer level was useful to judge prognosis of septic patients, and it would provide more clinical information when used with SOFA, APACHE II scores together.