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The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit

Brain dysfunction is associated with poor outcome in critically ill patients. In a post hoc analysis of the Intensive Care over Nations (ICON) database, we investigated the effect of brain dysfunction on hospital mortality in critically ill patients. Brain failure was defined as a neurological seque...

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Autores principales: Crippa, Ilaria A., Taccone, Fabio S., Wittebole, Xavier, Martin-Loeches, Ignacio, Schroeder, Mary E., François, Bruno, Kotfis, Katarzyna, Ñamendys-Silva, Silvio A., Forceville, Xavier, Solé-Violán, Jordi, Fontes, Luis E., Vincent, Jean-Louis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146463/
https://www.ncbi.nlm.nih.gov/pubmed/33922414
http://dx.doi.org/10.3390/brainsci11050530
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author Crippa, Ilaria A.
Taccone, Fabio S.
Wittebole, Xavier
Martin-Loeches, Ignacio
Schroeder, Mary E.
François, Bruno
Kotfis, Katarzyna
Ñamendys-Silva, Silvio A.
Forceville, Xavier
Solé-Violán, Jordi
Fontes, Luis E.
Vincent, Jean-Louis
author_facet Crippa, Ilaria A.
Taccone, Fabio S.
Wittebole, Xavier
Martin-Loeches, Ignacio
Schroeder, Mary E.
François, Bruno
Kotfis, Katarzyna
Ñamendys-Silva, Silvio A.
Forceville, Xavier
Solé-Violán, Jordi
Fontes, Luis E.
Vincent, Jean-Louis
author_sort Crippa, Ilaria A.
collection PubMed
description Brain dysfunction is associated with poor outcome in critically ill patients. In a post hoc analysis of the Intensive Care over Nations (ICON) database, we investigated the effect of brain dysfunction on hospital mortality in critically ill patients. Brain failure was defined as a neurological sequential organ failure assessment (nSOFA) score of 3–4, based on the assumed Glasgow Coma Scale (GCS) score. Multivariable analyses were performed to assess the independent roles of nSOFA and change in nSOFA from admission to day 3 (ΔnSOFA) for predicting hospital mortality. Data from 7192 (2096 septic and 5096 non-septic) patients were analyzed. Septic patients were more likely than non-septic patients to have brain failure on admission (434/2095 (21%) vs. 617/4665 (13%), p < 0.001) and during the ICU stay (625/2063 (30%) vs. 736/4665 (16%), p < 0.001). The presence of sepsis (RR 1.66 (1.31–2.09)), brain failure (RR 4.85 (3.33–7.07)), and both together (RR 5.61 (3.93–8.00)) were associated with an increased risk of in-hospital death, but nSOFA was not. In the 3280 (46%) patients in whom ΔnSOFA was available, sepsis (RR 2.42 (1.62–3.60)), brain function deterioration (RR 6.97 (3.71–13.08)), and the two together (RR 10.24 (5.93–17.67)) were associated with an increased risk of in-hospital death, whereas improvement in brain function was not.
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spelling pubmed-81464632021-05-26 The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit Crippa, Ilaria A. Taccone, Fabio S. Wittebole, Xavier Martin-Loeches, Ignacio Schroeder, Mary E. François, Bruno Kotfis, Katarzyna Ñamendys-Silva, Silvio A. Forceville, Xavier Solé-Violán, Jordi Fontes, Luis E. Vincent, Jean-Louis Brain Sci Article Brain dysfunction is associated with poor outcome in critically ill patients. In a post hoc analysis of the Intensive Care over Nations (ICON) database, we investigated the effect of brain dysfunction on hospital mortality in critically ill patients. Brain failure was defined as a neurological sequential organ failure assessment (nSOFA) score of 3–4, based on the assumed Glasgow Coma Scale (GCS) score. Multivariable analyses were performed to assess the independent roles of nSOFA and change in nSOFA from admission to day 3 (ΔnSOFA) for predicting hospital mortality. Data from 7192 (2096 septic and 5096 non-septic) patients were analyzed. Septic patients were more likely than non-septic patients to have brain failure on admission (434/2095 (21%) vs. 617/4665 (13%), p < 0.001) and during the ICU stay (625/2063 (30%) vs. 736/4665 (16%), p < 0.001). The presence of sepsis (RR 1.66 (1.31–2.09)), brain failure (RR 4.85 (3.33–7.07)), and both together (RR 5.61 (3.93–8.00)) were associated with an increased risk of in-hospital death, but nSOFA was not. In the 3280 (46%) patients in whom ΔnSOFA was available, sepsis (RR 2.42 (1.62–3.60)), brain function deterioration (RR 6.97 (3.71–13.08)), and the two together (RR 10.24 (5.93–17.67)) were associated with an increased risk of in-hospital death, whereas improvement in brain function was not. MDPI 2021-04-23 /pmc/articles/PMC8146463/ /pubmed/33922414 http://dx.doi.org/10.3390/brainsci11050530 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Crippa, Ilaria A.
Taccone, Fabio S.
Wittebole, Xavier
Martin-Loeches, Ignacio
Schroeder, Mary E.
François, Bruno
Kotfis, Katarzyna
Ñamendys-Silva, Silvio A.
Forceville, Xavier
Solé-Violán, Jordi
Fontes, Luis E.
Vincent, Jean-Louis
The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit
title The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit
title_full The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit
title_fullStr The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit
title_full_unstemmed The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit
title_short The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit
title_sort prognostic value of brain dysfunction in critically ill patients with and without sepsis: a post hoc analysis of the icon audit
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146463/
https://www.ncbi.nlm.nih.gov/pubmed/33922414
http://dx.doi.org/10.3390/brainsci11050530
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