Sepsis in the Neurologic Intensive Care Unit: Epidemiology and Outcome

BACKGROUND: Sepsis is a major contributor to mortality in patients admitted to a general intensive care unit (ICU). Early recognition and treatment of sepsis is key in improving outcomes. The epidemiology and outcome of sepsis in neurologic ICU (NeuroICU) has not been evaluated. METHODS: We retrospectively identified all patients admitted to our 16-bed NeuroICU between June 2009 and December 2013 using the acute physiologic and chronic health evaluation (APACHE) outcomes database. We excluded patients admitted with an infection, such as meningitis, encephalitis, brain or spinal abscess, or with any other infection. We compared NeuroICU patients who did to NeuroICU patients who did not develop sepsis after ICU admission. The diagnosis of sepsis was based on the SCCM/ACCP consensus conference definition. RESULTS: There were a total of 2,025 patients, out of which 29 patients (1.4%) developed sepsis. Patients who developed sepsis had a trend towards older age (67 ± 13 vs. 61 ± 11 years, P = 0.07), a trend towards more male gender (69.0% vs. 51.5%, P = 0.07), significantly higher APACHE III scores (58 ± 17 vs. 43 ± 21, P = 0.0001), and significantly higher acute physiologic scores (APS) (43 ± 16 vs. 32 ± 18, P = 0.001) than patients who did not develop sepsis. Patients who developed sepsis had higher ICU mortality (41.4% vs. 5.1%, odds ratio (OR) = 13.1; 95% confidence interval (CI), 6.1 - 28.2, P < 0.0001), and higher hospital mortality (44.8% vs. 8.2%, OR = 9.0; 95% CI, 4.3 - 19.0, P < 0.0001). CONCLUSIONS: Sepsis developed in 1.4% of patients admitted to a NeuroICU. Predictors of sepsis development were comorbidities and worsening acute physiologic variables. Patients who developed sepsis had significantly higher mortality. Vigilance to development of sepsis in NeuroICU is paramount, especially in this era when early recognition and intervention of sepsis significantly improves outcomes.