Effect of fluid resuscitation on the cognitive prognosis of patients with septic encephalopathy: a prospective cohort study

Septic-associated encephalopathy (SAE) is a common complication of septic shock associated with substantial neurological and cognitive morbidity. While early, goal-directed fluid resuscitation prolongs survival, its effect on cognitive recovery in patients with SAE remains inadequately characterised. This study aimed to evaluate the association between fluid resuscitation adequacy and 30-day cognitive outcomes in patients with SAE by utilising transcranial Doppler ultrasonography (TCD) to monitor cerebral perfusion dynamics. In this prospective cohort study, 150 patients admitted with septic shock were enrolled and classified into SAE and non-SAE groups according to established clinical criteria. SAE patients received standardised fluid resuscitation and were stratified into successful resuscitation (SR) and unsuccessful resuscitation (UR) subgroups. TCD was performed 24 h, 48 h, 1 week, and 2 weeks after admission to evaluate cerebral perfusion. Cognitive function was assessed on day 30 using the Mini-Mental State Examination (MMSE). TCD demonstrated high diagnostic utility in identifying SAE among septic shock patients. Significant differences in the rate of TCD-confirmed cerebral perfusion normalisation were observed between the SR and UR subgroups at 48 h, 1 week, and 2 weeks (all p < 0.05). Similarly, compared with the UR subgroup, the SR subgroup had significantly higher 30-day MMSE scores, indicating superior cognitive recovery. Effective fluid resuscitation in septic shock patients has positive implications for neurological recovery and medium- to long-term cognitive improvement. TCD exhibits favourable efficacy and operational feasibility for the evaluation of neurological outcomes for prognostic purposes, thus supporting its integration into clinical decision-making protocols.