Clinical image of sepsis-associated encephalopathy midst E. coli urosepsis: Emergency department database study

Ewa Magdalena Sokołowska; Paweł Wityk; Jacek Szypenbejl; Rafael Petrosjan; Joanna Raczak-Gutknecht; Małgorzata Waszczuk-Jankowska; Danuta Dudzik; Michał Markuszewski; Mariusz Siemiński

doi:10.1016/j.heliyon.2024.e29530

Clinical image of sepsis-associated encephalopathy midst E. coli urosepsis: Emergency department database study

Heliyon. 2024 Apr 10;10(8):e29530. doi: 10.1016/j.heliyon.2024.e29530. eCollection 2024 Apr 30.

Authors

Ewa Magdalena Sokołowska¹, Paweł Wityk², Jacek Szypenbejl³, Rafael Petrosjan¹, Joanna Raczak-Gutknecht², Małgorzata Waszczuk-Jankowska², Danuta Dudzik², Michał Markuszewski², Mariusz Siemiński³

Affiliations

¹ Emergency Department, University Clinical Center, Gdansk, Poland.
² Department of Biopharmaceutics and Pharmacodynamics, Medical University of Gdańsk, Gdańsk, Poland.
³ Department of Emergency Medicine, Medical University of Gdansk, Poland.

Abstract

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, which, if untreated, leads to multi-organ failure. One of the severe possible complications is sepsis associated encephalopathy (SAE), a neurological dysfunction occurring secondary to a severe inflammatory response. It manifests as acute cognitive dysfunction and sudden-onset dysfunctions in mental state. Uropathogenic Escherichia coli is the most common pathogen causing bacteremia, responsible for 80% of uncomplicated outpatient urinary tract infections and 40% of nosocomial infections. The study aimed to assess the difference in the severity and the course of urosepsis caused by E. coli in patients with and without septic encephalopathy.

Materials and methods: This study presents a retrospective analysis of the population of urosepsis patients admitted to the Emergency Department between September 2019 and June 2022. Inflammatory parameters, urinalysis and blood cultures were performed, along with a clinical evaluation of sepsis severity and encephalopathy. The patients were then stratified into SAE and non-SAE groups based on neurological manifestations and compared according to the collected data.

Results: A total of 199 septic patients were included in the study. E. coli-induced urosepsis was diagnosed in 84 patients. In this group, SAE was diagnosed in 31 (36.9%) patients (33.3% in males, 40.5% females). Patients with SAE were found to be hypotensive (p < 0,005), with a higher respiratory rate (p < 0,017) resulting in a higher mortality rate (p = 0.002) compared to non-SAE septic patients. The APACHE II score was an independent risk factor associated with a higher mortality rate. Biochemical parameters between the groups did not show any statistical importance related to the severity of urosepsis.

Conclusions: The severity of urosepsis and risk of SAE development increase according to the clinical condition and underlying comorbidities. Urosepsis patients with SAE are at a higher risk of death. Patients should undergo more careful screening for the presence of SAE on admission, and more intense monitoring and treatment should be provided for patients with SAE. This study indicates the need to develop projects aiming to further investigate neuroprotective interventions in sepsis.

Keywords: APACHE; Escherichia coli; Mental alteration; Sepsis associated encephalopathy; Urosepsis.