Severe sepsis-associated encephalopathy may worsen outcomes in ICU patients, suggests study

A recent study published in the Journal of Intensive Care highlighted that early systemic complications in critically ill patients with severe sepsis-associated encephalopathy (SAE) can significantly worsen outcomes if not corrected within the first 3 days of intensive care unit (ICU) admission. The data from the French OUTCOMEREA prospective multicenter database focused on the impact of persistent physiological abnormalities on 28-day mortality and neurological recovery.

Severe SAE is a life-threatening condition defined by altered consciousness (Glasgow Coma Scale score ≤13), accompanied by severe sepsis or septic shock necessitating invasive ventilation. The study analyzed nearly 995 ICU patients who met these criteria and excluded those with primary brain injuries.

The findings revealed that nearly 89% of patients expressed at least one systemic insult like abnormal blood sugar levels, blood pressure, body temperature, anemia, or respiratory function during the first 48 hours of ICU stay. The survivors had fewer systemic complications when compared to non-survivors.

Mostly, unresolved issues in blood pressure, oxygenation, glycemia, and body temperature by day 3 were independently associated with increased mortality risks. Uncorrected hypotension raised mortality risk by 77% (aHR = 1.77). And, persistent abnormalities in oxygen levels increased mortality by 78% (aHR = 1.78).

Failure to normalize body temperature elevated the risk by 46% (aHR = 1.46). Persistent abnormal blood sugar levels heightened mortality risk by 41% (aHR = 1.41). Also, unresolved blood pressure, temperature, and glycemic abnormalities were associated with decreased chances of regaining neurological function, defined as achieving a GCS score >13.

This study underlines the critical importance of addressing physiological imbalances early in the ICU stay to improve survival and recovery prospects for patients with severe SAE. The findings advocate for increased vigilance and targeted interventions during the initial days of treatment to manage these potentially reversible complications.

Overall, the research illuminates into improving care for one of the most vulnerable patient populations by emphasizing the role of early systemic stabilization in reducing the consequences of severe sepsis-associated encephalopathy.

Reference:

Thy, M., Sonneville, R., Ruckly, S., Mourvillier, B., Schwebel, C., Cohen, Y., Garrouste-Orgeas, M., Siami, S., Bruel, C., Reignier, J., Azoulay, E., Argaud, L., Goldgran-Toledano, D., Laurent, V., Dupuis, C., Poujade, J., Bouadma, L., de Montmollin, E., Timsit, J.-F., & on the behalf of the OUTCOME R. E. A. network. (2025). Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening—an analysis of the OUTCOMEREA database. Journal of Intensive Care, 13(1). https://doi.org/10.1186/s40560-024-00773-9