title: Early prediction and outcome of septic encephalopathy in acute stroke patients with nosocomial coma.
abstract: BACKGROUND
  Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC).
  
  
  METHODS
  A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with or without SE. Risk factors for patients with SE were compared with those without SE by univariate and multivariate analysis.
  
  
  RESULTS
  Of 94 stroke patients with NC, 46 (49%) had NC with SE and 48 (51%) had NC without SE. The onset-to-NC time was significant later in stroke patients with SE than those without SE (P < 0.01). There was a significant difference in body temperature, heart rate, respiratory rate, white blood cell (WBC), systolic blood pressure (SBP), diastolic blood pressure (DBP), systemic inflammatory response syndrome (SIRS), acute respiratory failure, septic shock, hypernatremia, and sequential organ failure assessment (SOFA) score between the SE and non-SE group (P < 0.05). On a repeat head imaging, vasogenic edema (P = 0.023) and subcortical white matter lesions (P = 0.011) were significantly higher in patients with SE than those without SE, while hematoma growth (P = 0.000), infarction progress (P = 0.003), and recurrent subarachnoid hemorrhage (SAH) (P = 0.011) were significantly lower in patients with SE than those without SE. Patients with SE had higher adjusted rates of fever ≥ 39 °C (odds ratio (OR): 2.753; 95% confidence interval (CI): 1.116 - 6.794; P = 0.028) and SIRS ≥ 3 items (OR: 6.459; 95% CI: 2.050 - 20.351; P = 0.001). The 30-day mortality in stroke patients with SE was higher than those without SE (76.1% vs. 45.8%, P = 0.003).
  
  
  CONCLUSIONS
  High fever and severe SIRS are two early predictors of stroke patients with SE, and survival rates were worse in stroke patients with SE than those without SE.
authors.affiliation: Department of Neurology, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China ; Department of Neurology, the Affiliated Pingxiang Hospital, Southern Medical University, China ; These authors contributed equally to this work and shared first authorship.
authors.forename: Dao-Ming
authors.initials: DM
authors.lastname: Tong
authors.affiliation: Medical Evaluation Unit, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China ; These authors contributed equally to this work and shared first authorship.
authors.forename: Ye-Ting
authors.initials: YT
authors.lastname: Zhou
authors.affiliation: Department of Neurology, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China.
authors.forename: Guang-Sheng
authors.initials: GS
authors.lastname: Wang
authors.affiliation: Department of Neurology, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Chen
authors.affiliation: Department of Neurology, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China.
authors.forename: Tong-Hui
authors.initials: TH
authors.lastname: Yang
keywords: Infection; Nosocomial coma; Outcome; Septic encephalopathy; Stroke; Systemic inflammatory response syndrome