Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
Int J Neurosci. 2023 Mar;133(3):327-333. doi: 10.1080/00207454.2021.1916489. Epub 2021 May 4.
Sepsis-associated encephalopathy (SAE) is a common manifestation of sepsis that may lead to cognitive decline. Our aim was to investigate whether the neurofilament light chain (NFL) and soluble triggering receptor expressed on myeloid cells 2 (sTREM2) could be utilized as prognostic biomarkers in SAE.
In this prospective observational study, baseline serum levels of sTREM2 and cerebrospinal fluid (CSF) levels of sTREM2 and NFL were measured by ELISA in 11 SAE patients and controls. Patients underwent daily neurological examination. Brain magnetic resonance imaging (MRI) and standard electroencephalography (EEG) were performed. Cognitive dysfunction was longitudinally assessed after discharge in 4 SAE patients using the Mini-Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination-Revised (ACE-R) tests.
SAE patients showed higher CSF sTREM2 and NFL levels than controls. sTREM2 and NFL levels were not correlated with the severity measures of sepsis. Three months after discharge, 2 SAE patients displayed ACE-R scores congruent with mild cognitive impairment (MCI), persisting in one patient 12 months after discharge. SAE patients with MCI showed higher CSF NFL levels, bacteremia, and abnormal brain MRI. Patients with increased serum/CSF sTREM2 levels showed trends towards displaying poorer attention/orientation and visuo-spatial skills.
sTREM2 and NFL levels may serve as a prognostic biomarker for cognitive decline in SAE. These results lend further support for the involvement of glial activation and neuroaxonal degeneration in the physiopathology of SAE.
脓毒症相关性脑病（SAE）是脓毒症的常见表现，可能导致认知能力下降。我们的目的是研究神经丝轻链（NFL）和髓样细胞表达的可溶性触发受体 2（sTREM2）是否可作为 SAE 的预后生物标志物。
在这项前瞻性观察性研究中，通过 ELISA 测量了 11 例 SAE 患者和对照组的基线血清 sTREM2 水平以及脑脊液（CSF）sTREM2 和 NFL 水平。患者接受了每日神经学检查。进行了脑磁共振成像（MRI）和标准脑电图（EEG）检查。在 4 例 SAE 患者出院后，使用简易精神状态检查（MMSE）和 Addenbrooke 的认知测验修订版（ACE-R）对认知功能障碍进行了纵向评估。
SAE 患者的 CSF sTREM2 和 NFL 水平高于对照组。sTREM2 和 NFL 水平与脓毒症严重程度测量无关。出院后 3 个月，2 例 SAE 患者的 ACE-R 评分符合轻度认知障碍（MCI），1 例患者在出院后 12 个月仍存在 MCI。具有 MCI 的 SAE 患者的 CSF NFL 水平较高，菌血症和异常脑 MRI。血清/CSF sTREM2 水平升高的患者表现出注意力/定向和视空间技能较差的趋势。
sTREM2 和 NFL 水平可能是 SAE 认知能力下降的预后生物标志物。这些结果进一步支持胶质细胞激活和神经轴突变性在 SAE 病理生理学中的作用。
