Sauer Martin, Sievert Anika, Wrobel Miroslaw, Schmude Paul, Richter Georg
Department of Anesthesiology and Intensive Care Medicine, University Hospital Rostock, Rostock, Germany.
Fraunhofer Institute Cell Therapy and Immunology, Leipzig, Germany.
Front Med Technol. 2022 Sep 14;4:920674. doi: 10.3389/fmedt.2022.920674. eCollection 2022.
Sepsis-associated encephalopathy (SAE) is a common organ dysfunction in patients with severe sepsis or septic shock and leads to higher mortality and longer hospital stay. The diagnosis remains an exclusion process; none of the available measurements are specific for SAE. The aim of the presented prospective and controlled clinical study was to evaluate the possible role of molecular acoustics in determining acute brain injury in septic patients using an acoustocerebrography (ACG) system. ACG is a multifrequency, transcranial ultrasound method that measures the attenuation and time of flight to detect changes in the brain tissue. After approval from the local research ethics committee (of the University Hospital of Rostock: Reg. No.: A 2016-0026), 20 patients were included in two study groups: septic shock group (SG) and control group (CG; postoperative nonseptic patients). All patients were screened several times with the ACG on different days. Blood parameters of organ function, sepsis-related organ failure assessment score, and delirium scores [Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC)] were obtained as well. A neurologist examined all patients at inclusion. Predictive analysis was done using a data-driven statistical method and by deriving a parameter from the ACG data. The study was registered under "clinicaltrials.gov" (Reg. No.: NCT03173196). All patients in the SG were CAM-ICU-positive at inclusion (ICDSC: in mean 4.0) and had clinical signs of SAE. In contrast, all patients in the CG were CAM-ICU-negative, with an ICDSC score of 0. Predictive analysis using the ACG data presented an accuracy of 83.4% with a specificity of 89.0% and a sensitivity of 75.1%. The ACG method may be helpful for the monitoring and diagnosing acute brain injury; however, the results of this first report should be verified by further clinical studies. Further investigations should include long-established instruments of SAE diagnosis, e.g., electroencephalography, MRI, and biomarkers, to compare the results with the ACG measurements.
脓毒症相关性脑病（SAE）是严重脓毒症或脓毒性休克患者常见的器官功能障碍，会导致更高的死亡率和更长的住院时间。其诊断仍然是一个排除过程；现有的检测方法均对SAE缺乏特异性。本前瞻性对照临床研究的目的是使用脑声图（ACG）系统评估分子声学在确定脓毒症患者急性脑损伤中的可能作用。ACG是一种多频经颅超声方法，通过测量衰减和飞行时间来检测脑组织的变化。经当地研究伦理委员会（罗斯托克大学医院：注册号：A 2016 - 0026）批准后，20名患者被纳入两个研究组：脓毒性休克组（SG）和对照组（CG；术后非脓毒症患者）。所有患者在不同日期多次接受ACG检查。还获取了器官功能的血液参数、脓毒症相关器官功能衰竭评估评分以及谵妄评分[重症监护病房意识模糊评估方法（CAM - ICU）和重症监护谵妄筛查清单（ICDSC）]。一名神经科医生在入组时对所有患者进行了检查。使用数据驱动的统计方法并从ACG数据中推导参数进行预测分析。该研究已在“clinicaltrials.gov”注册（注册号：NCT03173196）。SG组所有患者入组时CAM - ICU呈阳性（ICDSC：平均为4.0），并有SAE的临床体征。相比之下，CG组所有患者CAM - ICU呈阴性，ICDSC评分为0。使用ACG数据进行的预测分析准确率为83.4%，特异性为89.0%，敏感性为75.1%。ACG方法可能有助于监测和诊断急性脑损伤；然而，这一初步报告的结果应通过进一步的临床研究加以验证。进一步的研究应纳入SAE诊断的成熟手段，如脑电图、MRI和生物标志物，以便将结果与ACG测量结果进行比较。
