Elevated levels of the brain-specific S100B protein are present in many septic patients and reflect the severity of SAE. [ncbi.nlm.nih.gov]

Key historical findings are presented, and the reciprocal interactions between the brain and the immune system are examined. [books.google.com]

• Sepsis

  BACKGROUND: Encephalopathy is a common complication of sepsis, and its onset can occur at any stage of sepsis and implies worse prognosis. [ncbi.nlm.nih.gov]

• Multiple Organ Dysfunction Syndrome

  Central nervous system dysfunction as the first manifestation of multiple organ dysfunction syndrome in stem cell transplant patients. Bone Marrow Transplant 2000 ; 25 : 79 –83 ↵ Haire W. [ajnr.org]

  Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of Sequential Organ Failure Assessment scores in decision making. [journals.plos.org]

  Organ Damage Sepsis can evolve to multiple organ dysfunction syndrome (MODS), which has a mortality rate of between 30% and 50% (Nesseler, 2012). Damage to the vascular endothelium causes both edema and the collection of neutrophils and macrophages. [atrainceu.com]

• Acutely Ill Patient

  Vincent JL, Sakr Y, Sprung CL et al Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53 CrossRef PubMed Google Scholar 4. [link.springer.com]

  In Europe, severe sepsis affects 90.4 cases per 100 000 adult residents per year and an overall hospital mortality of 36% described in the last Sepsis Occurrence in Acutely ill Patients (SOAP) study [ 1 ]. [journals.plos.org]

• Anemia

  Transplantation was present in 46 of 49 patients (solid organ, 20; allo-BMT, 26), and 3 patients received cyclosporine for treatment of marrow disease (pure red cell aplasia, aplastic anemia). [ajnr.org]

  […] count is 3 when there is a significant risk of bleeding or If surgery or invasive procedures are planned, transfusion may occur with platelet counts ≥50,000/mm 3 (Dellinger et al., 2013b) The guidelines recommend against the use of erythropoietin for anemia [atrainceu.com]

• Wound Infection

  In 18 of these 21 patients, PRES occurred within 2 weeks of the infection and in 3 patients (1 each: abscess, wound infection, blast crisis with sepsis), neurotoxicity developed between 20 and 30 days of infection identification (overall average, 6.7 [ajnr.org]

• Confusion

  Patients underwent a daily cognitive assessment with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test. RESULTS: Twenty-one patients (55%) were found to present confusion. [ncbi.nlm.nih.gov]

  It can range from slight confusion to coma and can be, although rarely, accompanied by focal neurological signs. [scitechnol.com]

  This condition can cause mild confusion to deep coma. Wernicke encephalopathy Also known as Wernicke’s disease, this condition is a result of vitamin B-1 deficiency. [healthline.com]

   Defined as brain dysfunction due to sepsis and SIRS  Also called sepsis-associated delirium  Clinically, acute impairment in the level of consciousness and confusion (manifested by alteration in attention, disorientation and concentration up to [slideshare.net]

  […] consciousness that consists of three types: Type B: HE associated with portal-systemic bypass without intrinsic hepatocellular damage Type C: HE associated with end-stage liver disease (ESLD) or cirrhosis with portal-systemic shunt HE can range from minimal confusion [clinicaladvisor.com]

• Cognitive Impairment

  Definitions CCC — Long-term cognitive impairment in critically ill patients Journal articles Ebersoldt M, Sharshar T, Annane D. [lifeinthefastlane.com]

  Moreover, sepsis survivors can suffer from long-term cognitive impairments that impact their quality of life. [clinicaltrials.gov]

  It is characterized as an acute impairment of cognition, with a fluctuating course, impaired attention, and altered level of consciousness. [alvinandassociateslnc.com]

  It is unclear, however, how much of the risk for cognitive impairment after sepsis is due to pre-existing cognitive impairment, frailty, or lingering sedation effects, he said. [mdedge.com]

  Long-term sequelae of severe sepsis: cognitive impairment and structural brain alterations - an MRI study (LossCog MRI). [link.springer.com]

• Stupor

  "The first manifestation of SAE is an acute change in mental status, ranging from inattention, disorientation, agitation, somnolence, stupor and coma," the authors write. There is no specific treatment for SAE. [news-medical.net]

  SAE can also lead to stupor and coma. This is the most common encephalopathy in the ICU. [alvinandassociateslnc.com]

  Arousable by loud voice commands, but immediately lapses into stupor without further response. MAP failed to improve with further increase in norepinephrine. CPP < 50 despite increase of ventilatory rate in an effort to decrease ICP. [rense.com]

  The overall incidence rate ratio (IRR) for seizures among sepsis survivors was about 5, but was higher for those who also had neurologic dysfunction (such as encephalopathy, delirium, coma, or stupor) during their index hospitalization than in those without [mdedge.com]

• Altered Mental Status

  Clinical features of SAE include change in mental status (altered mental status/ AMS), disturbances in mental processes, agitation, disorientation, impaired attention, hypersomnolence, delirium or coma. [clinicaltrials.gov]

  The main sign of SAE is an altered mental status. Electroencephalography is the more sensitive diagnostic test, and allows the grading of the severity of cerebral dysfunction that is related to outcome. [ncbi.nlm.nih.gov]

  Like altered mental status, and unlike lactate, tachypnea does not require a blood test. [emdocs.net]

  mental status and seizures of 1 day duration. [neurologyindia.com]

  Neurotoxicity developed 6 days after positive cultures with altered mental status and blood pressure 128/80 mm Hg. [ajnr.org]

• Somnolence

  "The first manifestation of SAE is an acute change in mental status, ranging from inattention, disorientation, agitation, somnolence, stupor and coma," the authors write. There is no specific treatment for SAE. [news-medical.net]

  […] euphoria or anxiety, shortened attention span, impaired performance of addition or subtraction Grade II Lethargy or apathy, minimal disorientation for time or place, subtle personality change, inappropriate behavior, asterixis usually present Grade III Somnolence [clinicaladvisor.com]

  Somnolent but can be aroused, unable to perform mental tasks, gross disorientation about time and place, marked confusion, amnesia, occasional fits of rage, present but incomprehensible speech. Stage 4. [clevelandclinicmeded.com]

When seizure activity must be ruled out, an EEG may be helpful in the initial workup of a patient with cirrhosis and altered mental status. EEG studies are not required to make a confident diagnosis of HE. [clevelandclinicmeded.com]

• Staphylococcus Aureus

  Patients with biliary tract infections and intestinal infections caused by Staphylococcus aureus, Enterococcus faecium, Acinetobacter spp, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia, were more prone to develop sepsis-associated encephalopathy [ncbi.nlm.nih.gov]

  Identification of methicillin-resistant isolates of staphylococcus aureus and coagulase-negative staphylococci responsible for bloodstream infections with the Phoenix system. Diagn Microbiol Infect Dis 2004 ; 48 : 221 –27 ↵ Kotb M. [ajnr.org]

  A nitric oxide-inducible lactate dehydrogenase enables Staphylococcus aureus to resist innate immunity. Science 2008; 319: 1672–6. pmid:18356528 View Article PubMed/NCBI Google Scholar 26. [journals.plos.org]

  Methicillin-resistant Staphylococcus aureus (MRSA) is a growing cause of sepsis in the community as well as among hospitalized patients. [atrainceu.com]

• Streptococcus Pneumoniae

  It has been reported the essentiality of LDH in the virulence of fermentative microorganisms that causes bacteremia like Streptococcus pneumoniae [ 24 ], Staphylococcus aureus [ 25 ] or Enterococcus faecalis [ 26 ]. [journals.plos.org]

  She developed ARDS and Streptococcus pneumoniae sepsis 3 days after resection followed by pneumonia ( S aureus ) and line sepsis (coagulase-negative staphylococci). [ajnr.org]

METHODS: All patients received standard goal-directed resuscitation treatment. Patients with pre-existing or acute neurological disorders were excluded. [ncbi.nlm.nih.gov]

Found useful in animal model. 20.  Experimental treatment-Magnesium, glutamate release inhibitor riluzole or an antioxidant treatment, selective antagonists of pro-inflammatory cytokine receptors  Coupled plasma filtration adsorption, an extracorporal [slideshare.net]

SAE is potentially reversible, but it always worsens the prognosis. Pathophysiology of SAE is not still completely understood, and it is probably multifactorial. [ncbi.nlm.nih.gov]

They concluded that their metabolomic model was better in early identification of bad prognosis. [journals.plos.org]

"The spectrum of septic encephalopathy: definitions, etiologies, and mortalities." Jama 275.6 (1996): 470-473. Flierl, Michael A., et al. "Pathophysiology of septic encephalopathy—an unsolved puzzle." [derangedphysiology.com]

Interestingly - in patients - elevated procalcitonin was associated with delirum in both infectious and non-infectious etiologies. [pulmccm.org]

Definitions, etiologies, and mortalities. JAMA. 1996;275(6):470–3 CrossRef PubMed Google Scholar 7. Sonneville R, Verdonk F, Rauturier C et al. Understanding brain dysfunction in sepsis. [link.springer.com]

Pathophysiology There is not a single clear etiology that accounts for the occurrence of HE. [clinicaladvisor.com]

Etiology of cortical and white matter lesions in cyclosporin-A and FK-506 neurotoxicity. AJNR Am J Neuroradiol 2001 ; 22 : 1901 –14 ↵ Schwartz RB, Bravo SM, Klufas RA, et al. [ajnr.org]

However, the incidence, epidemiology, and pathogenesis of sepsis-associated encephalopathy remain controversial. The purpose of this study was to investigate the epidemiological features and risk factors for sepsis-associated encephalopathy. [ncbi.nlm.nih.gov]

Leng, Iris (committee member) Santos, Cesar (committee member) date 2009-08-07T14:13:06Z (accessioned) 2010-06-18T19:00:03Z (accessioned) 2009-08-07T14:13:06Z (available) 2010-06-18T19:00:03Z (available) 2009-08-07T14:13:06Z (issued) degree Clinical Epidemiology [wakespace.lib.wfu.edu]

Página 93 - Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. ‎ [books.google.es]

Sanford, JP (1985) Epidemiology and overview of the problem. In: Septic Shock pp. 1–11, Root, RK, Sande, MA (Eds) Churchill Livingstone, New York. [cambridge.org]

Although the pathophysiology of SAE is incompletely understood, it is thought to involve endothelial activation, blood-brain barrier leakage, inflammatory cell migration, and neuronal loss with neurotransmitter imbalance. [ncbi.nlm.nih.gov]

Further research into the pathophysiology, management and prevention of SAE is needed. This Review discusses the epidemiology and clinical presentation of SAE. [ncbi.nlm.nih.gov]

Current philosophy in sepsis management is drifting towards reactivating surviving “dysfunctional/hibernating” cells, including immune system’s own, rather than preventing the non-reachable acute destructive wave of immune activation. [research.pasteur.fr]

Página 220 - American Thoracic Society: Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. Am J Respir Crit Care Med 1995;153:1711. ‎ [books.google.es]