1Department of Internal Medicine, University General Hospital of Patras, Greece.
2Department of Internal Medicine, Section of Infectious Diseases, University General Hospital of Patras, Greece.
Rom J Intern Med. 2023 May 8;61(2):112-115. doi: 10.2478/rjim-2023-0005. Print 2023 Jun 1.
The sepsis syndrome is potentially affecting several organs and systems irrespectively of the primary source of the infection. Alterations of the brain function in sepsis patients may result either from a primary central nervous system (CNS) infection or could be part of the sepsis-associated encephalopathy (SAE), a common complication of sepsis, characterized by a diffuse dysfunction of the brain due to an infection elsewhere in the body without overt CNS infection. Aim of the study was to evaluate the usefulness of electroencephalography and the biomarker neutrophil gelatinase-associated lipocalin (NGAL) when measured in the cerebrospinal fluid (CSF) in the management of these patients.
Patients presenting at the emergency department with altered mental status and signs of infection were included in this study. Among initial assessment and treatment of the patients based on the international guidelines for treating sepsis, NGAL was measured in the cerebrospinal fluid (CSF) using ELISA technique. Electroencephalography was performed when possible within 24 hours after admission and EEG abnormalities were recorded.
32 of 64 patients included in this study were diagnosed with central nervous system (CNS) infection. CSF NGAL was significantly higher in patients with CNS infection compared to patients without CNS infection (18.1 [5.1-71.1] vs 3.6 [1.2-11.6]; p<0.001). There was a trend for higher CSF NGAL in patients with EEG abnormalities, which did not reach statistical significance (p=0.106). CSF NGAL levels were similar between survivors and non-survivors (medians: 7.04 vs 11.79).
In patients presenting at the emergency department with altered mental status and signs of infection, CSF NGAL was significantly higher in patients with CSF infection. Its role in this acute setting should be evaluated further. CSF NGAL could be suggestive of EEG abnormalities.
脓毒症综合征可能会影响多个器官和系统，而与感染的初始来源无关。脓毒症患者的大脑功能改变可能是由中枢神经系统（CNS）原发性感染引起的，也可能是脓毒症相关脑病（SAE）的一部分，这是脓毒症的常见并发症，其特征是由于身体其他部位的感染而导致大脑弥漫性功能障碍，而没有明显的 CNS 感染。本研究旨在评估脑电图和生物标志物中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在测量脑脊液（CSF）中的作用，以指导这些患者的治疗。
本研究纳入了因精神状态改变和感染迹象而就诊于急诊科的患者。在根据治疗脓毒症的国际指南对患者进行初始评估和治疗的基础上，使用 ELISA 技术测量脑脊液（CSF）中的 NGAL。患者入院后 24 小时内尽可能进行脑电图检查，并记录脑电图异常。
本研究共纳入 64 例患者，其中 32 例被诊断为中枢神经系统（CNS）感染。与无 CNS 感染的患者相比，CNS 感染患者的 CSF NGAL 明显更高（18.1[5.1-71.1] vs 3.6[1.2-11.6]；p<0.001）。脑电图异常患者的 CSF NGAL 水平更高，但未达到统计学意义（p=0.106）。幸存者和非幸存者的 CSF NGAL 水平相似（中位数：7.04 与 11.79）。
在因精神状态改变和感染迹象而就诊于急诊科的患者中，CSF NGAL 在 CSF 感染患者中明显更高。其在这种急性情况下的作用需要进一步评估。CSF NGAL 可能提示脑电图异常。
