{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T12:53:52Z","timestamp":1793364832341,"version":"4.5.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["j intensive care"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Sepsis-associated encephalopathy (SAE) may be worsened by early systemic insults. We aimed to investigate the association of early systemic insults with outcomes of critically ill patients with severe SAE.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We performed a retrospective analysis using data from the French OUTCOMEREA prospective multicenter database. We included patients hospitalized in intensive care unit (ICU) for at least 48\u00a0h with severe SAE (defined by a score on the Glasgow Coma Scale (GCS)\u2009\u2264\u200913 and severe sepsis or septic shock (SEPSIS 2.0 criteria)) requiring invasive ventilation and who had no primary brain injury.<\/jats:p>\n            <jats:p>We analyzed early systemic insults (abnormal glycemia (&lt;\u20093\u00a0mmol\/L or\u2009\u2265\u200911\u00a0mmol\/L), hypotension (diastolic blood pressure\u2009\u2264\u200950\u00a0mmHg), temperature abnormalities (&lt;\u200936\u00a0\u00b0C or\u2009\u2265\u200938.3\u00a0\u00b0C), anemia (hematocrit\u2009&lt;\u200921%), dysnatremia (&lt;\u2009135\u00a0mmol\/L or\u2009\u2265\u2009145\u00a0mmol\/L), oxygenation abnormalities (PaO<jats:sub>2<\/jats:sub>\u2009&lt;\u200960 or\u2009&gt;\u2009200\u00a0mmHg), carbon dioxide abnormalities (&lt;\u200935\u00a0mmHg or\u2009\u2265\u200945\u00a0mmHg), and the impact of their correction at day 3 on day-28 mortality and awakening, defined as a recovery of GCS\u2009&gt;\u200913.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>We included 995 patients with severe SAE, of whom 883 (89%) exhibited at least one early systemic insult that persisted through day 3. Compared to non-survivors, survivors had significantly less early systemic insults (hypoglycemia, hypotension, hypothermia, and anemia) within the first 48\u00a0h of ICU admission. The absence of correction of the following systemic insults at day 3 was independently associated with mortality: blood pressure (adjusted hazard ratio (aHR)\u2009=\u20091.77, 95% confidence interval (CI) 1.34\u20132.34), oxygenation (aHR\u2009=\u20091.78, 95% CI 1.20\u20132.63), temperature (aHR\u2009=\u20091.46, 95% CI 1.12\u20131.91) and glycemia (aHR\u2009=\u20091.41, 95% CI 1.10\u20131.80). Persistent abnormal blood pressure, temperature and glycemia at day 3 were associated with decreased chances of awakening.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>In patients with severe SAE, the persistence of systemic insults within the first three days of ICU admission is associated with increased mortality and decreased chances of awakening.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s40560-024-00773-9","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T04:33:57Z","timestamp":1736829237000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening\u2014an analysis of the OUTCOMEREA database"],"prefix":"10.1186","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9366-505X","authenticated-orcid":false,"given":"Michael","family":"Thy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Sonneville","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Ruckly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Mourvillier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Schwebel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mait\u00e9","family":"Garrouste-Orgeas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shidasp","family":"Siami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric","family":"Bruel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Reignier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie","family":"Azoulay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Argaud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dany","family":"Goldgran-Toledano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Laurent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Dupuis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Poujade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lila","family":"Bouadma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"de Montmollin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Fran\u00e7ois","family":"Timsit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on the behalf of the OUTCOME R. 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