Predicting outcomes in patients with sepsis-associated encephalopathy using prefrontal functional connectivity analysis

We investigated the relationship between prefrontal functional connectivity of oxyhemoglobin and outcomes in sepsis-associated encephalopathy (SAE). Additionally, we developed a prognostic method for patients with SAE. A total of 40 consecutive patients with SAE were prospectively included. Cerebral oxyhemoglobin data were obtained using functional near-infrared spectroscopy. Functional connectivity such as density was evaluated as the strength of the temporal correlation between channels based on Pearson's correlation coefficient of oxyhemoglobin. We obtained clinical information and evaluated severity scores using Acute Physiology and Chronic Health Evaluation (APACHE) III. Outcomes were evaluated using the modified Rankin Scale (mRS) at discharge. Patients were categorized into two groups: good outcome (mRS 0-3), and poor outcome (mRS 4-6). Among the patients with SAE, 17 (42.5%) had good outcomes. Regarding connectivity analysis, density values were significantly higher in good outcome groups at all threshold values. The developed predictive method of good outcomes using the density value at a threshold of 0.6 and the APACHE III score showed very good predictive power (area under the curve 0.951 [95% confidence interval 0.893-1.00]). This method had better discrimination powers for predicting outcome than density had at 0.6 (0.716 [0.557-0.876]; P = 0.04) or the APACHE III score had alone (0.857 [0.735-0.979]; P = 0.09). A higher functional connectivity value of oxyhemoglobin in the prefrontal connectivity analysis was associated with good outcomes in SAE. Functional connectivity analysis of the prefrontal cortex and sepsis severity may help predict the prognosis in SAE patients.