Search Results (4)

Background: This study aims to elucidate the relationship between serum sodium and the risk of sepsis-associated delirium (SAD), with particular emphasis on the critical threshold of 138.4 mmol/L. Methods: The retrospective study utilized data from the MIMIC-IV database. The analysis focused on serum sodium concentrations measured within the first 24 h of ICU admission. The association between sodium levels and the risk of delirium was assessed using restricted cubic spline (RCS) analysis and multivariable logistic regression. Subgroup analyses and propensity score matching (PSM) were used to mitigate potential confounding factors. Results: A total of 7356 septic patients were included, with 1861 (25.3%) developing delirium. RCS analysis revealed a significant non-linear relationship between sodium levels and delirium risk, with a threshold at 138.4 mmol/L. Sodium levels ≤ 138.4 mmol/L were associated with a reduced risk of delirium (OR 0.97, 95% CI: 0.95–0.99, p = 0.041), while levels > 138.4 mmol/L significantly increased the risk of delirium (OR 1.08, 95% CI: 1.06–1.11, p < 0.001). After PSM, hypernatremia was associated with a higher delirium incidence than hyponatremia (55.00% vs. 36.67%, p = 0.044) and remained an independent risk factor for delirium in logistic regression (OR 2.89, 95% CI 1.17–7.18, p = 0.022). Conclusions: This study identified a non-linear, threshold-dependent association between serum sodium and delirium susceptibility in septic patients, with 138.4 mmol/L as a critical tipping point. Hypernatremia emerged as a more potent risk factor for delirium compared to hyponatremia. These findings underscore the importance of sodium management in septic patients and suggest that serum sodium may serve as a potential biomarker for predicting neuropsychiatric outcomes in sepsis. Full article

Patients with sepsis-associated delirium (SAD) show severe neurological impairment, often require an intensive care unit (ICU) stay and have a high risk of mortality. Hence, useful biomarkers for early detection of SAD are urgently needed. Extracellular vesicles (EVs) and their cargo are known to maintain normal physiology but also have been linked to numerous disease states. Here, we sought to identify differentially expressed proteins in plasma EVs from SAD patients as potential biomarkers for SAD. Plasma EVs from 11 SAD patients and 11 age-matched septic patients without delirium (non-SAD) were isolated by differential centrifugation, characterized by nanoparticle tracking analysis, transmission electron microscopy and Western blot analysis. Differential EV protein expression was determined by mass spectrometry and the resulting proteomes were characterized by Gene Ontology term and between-group statistics. As preliminary results because of the small group size, five distinct proteins showed significantly different expression pattern between SAD and non-SAD patients (p ≤ 0.05). In SAD patients, upregulated proteins included paraoxonase-1 (PON1), thrombospondin 1 (THBS1), and full fibrinogen gamma chain (FGG), whereas downregulated proteins comprised immunoglobulin (IgHV3) and complement subcomponent (C1QC). Thus, plasma EVs of SAD patients show significant changes in the expression of distinct proteins involved in immune system regulation and blood coagulation as well as in lipid metabolism in this pilot study. They might be a potential indicator for to the pathogenesis of SAD and thus warrant further examination as potential biomarkers, but further research is needed to expand on these findings in longitudinal study designs with larger samples and comprehensive polymodal data collection. Full article

Delirium is characterized by an acutely altered mental status accompanied by reductions in cognitive function and attention. Delirium in septic patients, termed sepsis-associated delirium (SAD), differs in several specific aspects from the other types of delirium that are typically encountered in intensive care units. Since sepsis and delirium are both closely associated with increased morbidity and mortality, it is important to not only prevent but also promptly diagnose and treat SAD. We herein reviewed the etiology, pathogenesis, risk factors, prevention, diagnosis, treatment, and prognosis of SAD, including coronavirus disease 2019 (COVID-19)-related delirium. Delirium by itself not only worsens long-term prognosis, but it is also regarded as an important factor affecting the outcome of post-intensive care syndrome. In COVID-19 patients, the difficulties associated with adequately implementing the ABCDEF bundle (Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials: Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; Family engagement/empowerment) and the need for social isolation are issues that require the development of conventional care for SAD. Full article

Sepsis is a potentially life-threatening condition caused by a systemic dysregulated host response to infection. The brain is particularly susceptible to the effects of sepsis with clinical manifestations ranging from mild confusion to a deep comatose state. Sepsis-associated delirium (SAD) is a cerebral manifestation commonly occurring in patients with sepsis and is thought to occur due to a combination of neuroinflammation and disturbances in cerebral perfusion, the blood brain barrier (BBB) and neurotransmission. The neurological impairment associated with SAD can persist for months or even longer, after the initial septic episode has subsided which may impair the rehabilitation potential of sepsis survivors. Early identification and treatment of the underlying sepsis is key in the management of SAD as once present it can be difficult to control. Through the regular use of validated screening tools for delirium, cases of SAD can be identified early; this allows potentially aggravating factors to be addressed promptly. The usefulness of biomarkers, neuroimaging and electroencephalopathy (EEG) in the diagnosis of SAD remains controversial. The Society of Critical Care Medicine (SCCM) guidelines advise against the use of medications to treat delirium unless distressing symptoms are present or it is hindering the patient’s ability to wean from organ support. Full article