Risk factors of sepsis-associated encephalopathy in sepsis patients with pulmonary infection: from the secondary analysis of a cluster-randomized controlled trial.

BACKGROUND & AIMS: The risk factors for sepsis-associated encephalopathy (SAE) secondary to pulmonary infection remain unclear. This study aimed to determine the prevalence and identify the risk factors of SAE in this specific sepsis population.

METHODS

In this secondary analysis of the cluster-randomized controlled trial. We screened 603 sepsis patients with pulmonary infection. Least absolute shrinkage and selection operator (LASSO) regression was used for potential variables selection. Selected variables were then included in a multivariable logistic regression model to identify the potential independent risk factors for SAE. Cox proportional hazard models were used to assess its impact on 28-day mortality.

RESULTS

A total of 603 sepsis patients with pulmonary infection at ICU admission, of whom 411 (68 %) had SAE, were included in this study. LASSO regression identified 19 potential variables, and the following factors remained independently associated with SAE: acute gastrointestinal injury (AGI)-II (OR = 1.86, 95 % CI: 1.18-2.98, P = 0.008), elevated serum lactate (OR = 1.25, 95 % CI: 1.10-1.44, P = 0.001), hypernatremia (OR = 1.93, 95 % CI: 1.07-3.62, P = 0.034), and BUN (OR = 1.03, 95 %CI:1.0-1.05, P = 0.025). SAE was associated with higher mortality, with an adjusted HR of 1.61 (95 % CI: 1.04-2.47, P = 0.031).

CONCLUSION

These findings indicate that SAE is closely associated with prognosis in sepsis induced by pulmonary infection. The primary independent risk factors identified were acute gastrointestinal injury (AGI) severity, elevated serum lactate, hypernatremia, and increased blood urea nitrogen (BUN).