A Case Of Sepsis-associated Encephalopathy With Literature Review

BackgroundSepsis is a common and frequently occurring disease in the field of acute and critical illness,and its definition has changed greatly in recent years.Currently,the definition used is that for patients with infection or suspected infection,sepsis can be diagnosed when the Sequential Organ Failure Assessment(SOFA)score rises by more than 2 points from the baseline.The incidence of sepsis in different countries and regions is relatively high,ranging from 1.4-25% and the mortality rate is 30-70%.The pathogenesis of sepsis has not been fully clarified so far,and it is currently believed that systemic inflammatory response syndrome plays an important role in its pathogenesis.Although different advances have been made in the treatment of sepsis,such as fluid resuscitation,anti-infective therapy,use of vasoactive substances,application of glucocorticoids,anticoagulation,and blood purification,no specific drug treatment has been found.At the same time,sepsis has a variety of complications,such as acute kidney injury(AKI),disseminated intravascular coagulation(DIC),sepsis-associated encephalopathy(SAE),etc.Sepsis-associated encephalopathy,also known as sepsis encephalopathy,refers to the state of disease in which patients have diffuse brain dysfunction caused by systemic inflammatory reaction of sepsis without clinical or laboratory evidence of central nervous system infection or organic lesions,which seriously affects the function of nervous system.Patients with SAE all have signs of severe systemic infection,manifested as sepsis or systemic inflammatory response syndrome(SIRS).However,the pathophysiological mechanism of SAE is very complex,and no specific and effective treatment has been found.Moreover,the early clinical manifestations of SAE are not easy to be found,and there are certain difficulties in evaluating patients' consciousness and cognitive impairment.The application of sedatives and the hypotension and metabolic disorders of patients themselves also lead to encephalopathy,and lack of specific diagnostic criteria,resulting in large differences in the incidence of SAE and high rates of misdiagnosis.This paper aims to retrospectively analyze the diagnosis and treatment of a case of SAE in our hospital,and discuss the clinical efficacy of SAE treatment combined with review of relevant literature.ObjectiveTo analyze the diagnosis and treatment process of a patient with SAE in our hospital,to explore the clinical characteristics and diagnosis and treatment methods of SAE,and to improve the understanding of the diagnosis of SAE,optimize the treatment,predict and improve the prognosis of patients in combination with relevant literature analysis.MethodsThe clinical data of a case of SAE admitted to the Department of Critical Care Medicine of Guangzhou First People's Hospital were collected,and the relevant auxiliary examinations,including plain CT scan + enhancement,electroencephalogram,intracranial pressure measurement,cerebrospinal fluid culture,etc.,were combined with relevant literature to analyze the diagnosis,treatment and prognosis of SAE.Results1.Characteristics of this case:(1)The patient was an elderly male(2)He came to our hospital for treatment due to diarrhea and fever,and his condition progressed rapidly with high fever(T:39.5 C).Physical examination showed coma,increased heart rate,decreased blood pressure,cold limbs,skin spots,slightly tight abdomen,no tenderness,rebound pain,neck resistance,light reflex,corneal reflex,high muscle tension of limbs,muscle strength grade I,normal tendon reflex,positive right babinski,other neuropathological signs were not elicited.(3)Imaging examination: no abnormality was found in cranial imaging results(4)Laboratory examination: the infection index increased,such as PCT: 17.13 mmol/L;the inflammation index increased,such as Il-6: 159.31 pg/ml,C-reactive protein: 55.4 mg/L,TNF-a: 17.33 pg/ml;the circulation index was poor,such as: lactic acid 9.4 mmol/L,blood culture result: Escherichia coli.(5)Lumbar puncture results: high intracranial pressure(310mm H2O),the rest of the cerebrospinal fluid test results showed no abnormalities.(6)Critical illness severity score: Glass score: 4 points,SOFA score: 11 points,APACHE II score: 22 points.(7)EEG results: severe abnormal EEG.In combination with the above criteria,sepsis was diagnosed.After excluding cerebrovascular accident,metabolic encephalopathy,craniocerebral trauma and intracranial infection,SAE was diagnosed considering the change of patient's mind to secondary changes.Continue to give anti-infection and other positive symptomatic treatment,the patient's mind recovered,EEG improved compared with before.2.Systematic review of the literature results:(1)The rapid progress of sepsis,timely anti-infection treatment and improvement of etiological examination are the key measures to improve the prognosis of patients and reduce mortality.(2)The main clinical manifestations of SAE are changes in consciousness and consciousness.And the mortality rate of patients with SAE sepsis is high(3)At present,the detailed pathogenesis of SAE has not been fully elucidated.(4)Electroencephalogram is currently an important auxiliary examination for the diagnosis and differentiation of SAE.Conclusion1.Sepsis is prone to multiple complications,SAE is one of them.However,the clinical manifestations of SAE are mainly mental changes,which are easy to be missed and misdiagnosed.Early identification and diagnosis are the key to improve the prognosis.2.At present,the diagnosis of SAE lacks gold standard,and is still dominated by "exclusive diagnosis".EEG results play an important role in diagnosis.3.Removal of etiology,symptomatic supportive treatment and management are the current principles of SAE treatment.4.Dynamic reexamination of ECG,NSE,cytokines and other auxiliary examinations can effectively help clinicians to diagnose the prognosis of patients.