Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, 1-396, Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
Crit Care. 2021 Nov 29;25(1):411. doi: 10.1186/s13054-021-03828-7.
Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings' relationship to risk factors and outcomes.
Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included (n = 48). The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the "brain atrophy group (n = 42)", and those with ≥ 0% were defined as the "no brain atrophy group (n = 6)." Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups.
Analysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. second CT scan: 1.002 ± 0.121 L, t (41) = 9.436, p < 0.001). The mean percentage change in brain volume between CT scans in the brain atrophy group was -3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm. The proportion of cases on mechanical ventilation (95.2% vs. 66.7%; p = 0.02) and median time on mechanical ventilation (28 [IQR 15-57] days vs. 15 [IQR 0-25] days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group.
Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation.
败血症常伴有多器官衰竭；然而，败血症患者的脑容量变化尚不清楚。我们使用脑计算机断层扫描（CT）评估败血症急性期的脑萎缩，并分析其发现与危险因素和结果的关系。
纳入入住重症监护病房（ICU）且住院期间至少行 2 次头颅 CT 检查的败血症患者（n=48）。首次头颅 CT 于入院时常规进行，当意识持久障碍或出现异常神经学表现时，进行第 2 次及以后的头颅 CT 检查。使用自动分割方法估计脑容量，记录两次扫描之间脑容量的任何变化。第 1 次 CT 扫描至第 2 次 CT 扫描脑容量变化＜0%的患者定义为“脑萎缩组（n=42）”，脑容量变化≥0%的患者定义为“无脑萎缩组（n=6）”。比较两组患者机械通气使用率和时间、ICU 住院时间、住院时间和死亡率。
脑萎缩组 42 例患者的脑容量均明显减少（第 1 次 CT 扫描：1.041±0.123 L vs. 第 2 次 CT 扫描：1.002±0.121 L，t（41）=9.436，p＜0.001）。脑萎缩组 CT 扫描间脑容量的平均百分比变化为-3.7%，中位数为 31 天，相当于脑容量减少了 38.5 cm。脑萎缩组机械通气比例（95.2% vs. 66.7%；p=0.02）和机械通气中位时间（28 [IQR 15-57] 天 vs. 15 [IQR 0-25] 天，p=0.04）均显著高于无脑萎缩组。
许多发生持久意识状态改变和神经后遗症的重症败血症 ICU 患者出现脑萎缩迹象。脑萎缩进展迅速的患者更可能需要机械通气。
