title: Cerebral perfusion alterations and cognitive decline in critically ill sepsis survivors.
abstract: BACKGROUND
  We investigated the association between cerebral perfusion perturbations in sepsis with possible cognitive decline (CD) after patients' discharge from the intensive care unit (ICU).
  
  
  METHODS
  We studied 28 patients with sepsis and Lawton's Instrumental Activities of Daily Living scale (IADL) scores ≥5 who were discharged from a university ICU institution. We evaluated cerebral circulatory parameters (pulsatility index (PI) and cerebral blood flow index (CBFi) was calculated based on the measured velocity of the middle cerebral artery. Use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test was performed daily, and either the Mini Mental State Examination test (MMSE) or Clock Drawing test was performed at ICU discharge. CD was categorized as persistent coma, positive CAM-ICU test at discharge, MMSE <24, or an abnormal Clock test.
  
  
  RESULTS
  Patients had a median pre-ICU IADL score of 6.3 (95% CI 5.9-6.7). Fourteen patients (50%) had CD at discharge. Two were in persistent coma despite sepsis resolution. Information recall was the most affected mental function of the other 12 patients. Only on the first day, patients with CD had higher PI and lower CBFi compared to those without CD (2.2 ± 0.7 vs. 1.4 ± 0.5, p = 0.02; 363 ± 170 vs. 499 ± 133, p = 0.03, respectively). Multivariable analysis revealed delirium, but not PI, as an independent prognostic factor for CD (OR: 29.62, 95%CI 1.91-458.01, p = 0.01).
  
  
  CONCLUSIONS
  Delirium, but not cerebral perfusion alterations, is an independent risk factor for cognitive impairment in septic patients who were discharged from the ICU.
authors.affiliation: a Intensive Care Department , Brugmann University Hospital, Université Libre de Bruxelles , Bruxelles , Belgium.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Pierrakos
authors.affiliation: a Intensive Care Department , Brugmann University Hospital, Université Libre de Bruxelles , Bruxelles , Belgium.
authors.forename: Rachid
authors.initials: R
authors.lastname: Attou
authors.affiliation: b Geriatrics Department , Brugmann University Hospital, Université Libre de Bruxelles , Bruxelles , Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Decorte
authors.affiliation: c Internal Medicine Department , University Hospital of Patras , Patra , Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Velissaris
authors.affiliation: a Intensive Care Department , Brugmann University Hospital, Université Libre de Bruxelles , Bruxelles , Belgium.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cudia
authors.affiliation: a Intensive Care Department , Brugmann University Hospital, Université Libre de Bruxelles , Bruxelles , Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gottignies
authors.affiliation: a Intensive Care Department , Brugmann University Hospital, Université Libre de Bruxelles , Bruxelles , Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Devriendt
authors.affiliation: d 3rd Department of Neurology , Aristotle University of Thessaloniki , Thessaloniki , Greece.
authors.forename: Magda
authors.initials: M
authors.lastname: Tsolaki
authors.affiliation: a Intensive Care Department , Brugmann University Hospital, Université Libre de Bruxelles , Bruxelles , Belgium.
authors.forename: David
authors.initials: D
authors.lastname: De Bels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation; D060825:Cognitive Dysfunction / Q000209:etiology*; D016638:Critical Illness; D003693:Delirium / Q000150:complications; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D017741:Survivors
keywords: Cognitive decline; Delirium; Encephalopathy; Pulsatility index; Sepsis; Transcranial Doppler