Comparative Analyses of the Impact of Different Criteria for Sepsis Diagnosis on Outcome in Patients with Spontaneous Subarachnoid Hemorrhage

Abstract

Data on sepsis in patients with a subarachnoid hemorrhage (SAH) are scarce. We assessed the impact of different sepsis criteria on the outcome in an SAH cohort. Adult patients admitted to our ICU with a spontaneous SAH between 11/2014 and 11/2018 were retrospectively included. In patients developing an infection, different criteria for sepsis diagnosis (Sepsis-1, Sepsis-3_original, Sepsis-3_modified accounting for SAH-specific therapy, alternative sepsis criteria compiled of consensus conferences) were applied and their impact on functional outcome using the modified Rankin Scale (mRS) on hospital discharge and in-hospital mortality was evaluated. Of 270 SAH patients, 129 (48%) developed an infection. Depending on the underlying criteria, the incidence of sepsis and septic shock ranged between 21–46% and 9–39%. In multivariate logistic regression, the Sepsis-1 criteria were not associated with the outcome. The Sepsis-3 criteria were not associated with the functional outcome, but in shock with mortality. Alternative sepsis criteria were associated with mortality for sepsis and in shock with mortality and the functional outcome. While Sepsis-1 criteria were irrelevant for the outcome in SAH patients, septic shock, according to the Sepsis-3 criteria, adversely impacted survival. This impact was higher for the modified Sepsis-3 criteria, accounting for SAH-specific treatment. Modified Sepsis-3 and alternative sepsis criteria diagnosed septic conditions of a higher relevance for outcomes in patients with an SAH.

Association of sepsis and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

“…In a relatively small cohort of 98 aSAH patients, Budohosky et al found a trend towards increased odds of DCI in patients with sepsis (OR=4.4, 95%CI: 0.08-25.2; p=0.095) 9 . Although the used sepsis operationalization was shown to be important in studies on sepsis-associated outcomes in critically ill patients in general 18,31 and in patients with aSAH specifically 2,32 , neither of the aforementioned studies included details about the utilized sepsis definition. Additionally, both studies were performed before 2016 9,14 and did not apply the updated sepsis-3 definition that focuses on septic organ dysfunction 15 .…”

“…Hypodensities on CT imaging resulting from ventricular catheter or intraparenchymal hematoma were not regarded as cerebral infarctions from DCI 6 . Clinical management was performed as described in detail previously and the procedures followed were in accordance with institutional guidelines 2,19 . Since January 2016, an updated protocol for standardized detection and management of DCI was implemented by the Department of Neurosurgery in line with our previous studies 19–21 .…”

“…Hypodensities on CT imaging resulting from ventricular catheter or intraparenchymal hematoma were not regarded as cerebral infarctions from DCI 6 . Clinical management was performed as described in detail previously and the procedures followed were in accordance with institutional guidelines 2,19 .…”

“…Both sepsis and delayed cerebral ischemia (DCI) are severe complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) and are significant determinants for poor outcome [1][2][3][4] . The term DCI presents a pro-ischemic complication in patients who survive the initial aSAH ictus 5,6 .…”

S-Adenosylhomocysteine Is a Useful Metabolic Factor in the Early Prediction of Septic Disease Progression and Death in Critically Ill Patients: A Prospective Cohort Study

“…Upon study inclusion, the dynamic of patients’ status was assessed every 8 h for a period of 5 days, resulting in up to 15 evaluation time points. The assessment followed sepsis-1/2 definition criteria (neither SIRS nor sepsis (0), SIRS (1), sepsis (2), severe sepsis (3), or septic shock (4); for a detailed list of diagnostic sepsis-1/2 definition criteria, see Supplementary Table S5 [ 39 , 40 , 41 ]). Due to the initiation time of the study, the original prospective recruitment strategy was based on the sepsis-1/2 definition.…”