Prevalence, symptoms, risk factors and impact of sepsis-associated encephalopathy in emergency department patients: a case-control study

Global sepsis statistics exhibit a morbidity of 48.9 million with 11.0 million sepsis-related deaths. Despite ongoing research and guideline updates it remains a serious epidemiological concern. Sepsis-associated encephalopathy (SAE) is one of the more dangerous sepsis complications, due to its potential to cause permanent central nervous system damage. This study aimed to examine the prevalence, symptoms, risk factors, and impact of SAE on disease course in emergency department patients. This retrospective study was performed in an emergency department of a university hospital. We analyzed medical records of patients from January 2021 till the end of December 2022. All admitted patients diagnosed with sepsis according to the sepsis-3 consensus were included. Patients with disseminated neoplastic disease, chronic neurological conditions with impact on cognitive and communicative functions, and pediatric patients were excluded. Based on laboratory tests and clinical symptoms of encephalopathy, the patients were divided into SAE and non-SAE groups. Chi-square test was used to assess results’ significance. A total of 443 patients with sepsis were included in the study, of whom 240 presented with SAE. The most common SAE symptoms include general consciousness deterioration, disorientation, and somnolence. Patients with SAE were older and had heart failure more frequently. Mortality rate in the SAE group was significantly higher and equaled 45.42% vs 7.88% in the non-SAE group (p-value < 0.001). The most commonly identified pathogens in the blood cultures were Escherichia coli and Staphylococcus aureus. The study showed that SAE is a common sepsis complication (54% prevalence) that significantly increases in-hospital mortality. Older patients with chronic neurological disorders and heart failure are particularly vulnerable. The SOFA, NEWS, and Glasgow Coma Scale scores have proven to be reliable predictors of SAE occurrence. This study is not a clinical trial.