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Conséquences cognitives du sepsis : une étude longitudinale de la phase aiguë à 12 mois post-sepsis

par Maenhout, Christelle
Président du jury Fery, Patrick
Promoteur Gaspard, Nicolas
Co-Promoteur Peigneux, Philippe
Publication Non publié, 2021-09-08

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Résumé :

Background: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection1. One of the most commonly affected organ is the brain, leading to sepsis-associated encephalopathy (SAE). The prevalence of SAE widely varies between studies, between 10 to 75% of septic patients. It is characterized by a diffuse cerebral dysfunction ranging from delirium to coma, in the absence of direct brain damage or another cause of encephalopathy3–5. Despite improvements in critical care, SAE remains associated with increased mortality and cognitive disability. Sepsis is also associated with long term cognitive sequelae such as memory, attentional and executive functions deficits.Methods: Single-center prospective observational study of adult’s patients with sepsis without acute or chronic neuropsychiatric disorders and co-existing causes of encephalopathy between January 1, 2016, and August 30, 2020. During acute phase, we assessed the severity of sepsis, consciousness and arousal using four clinical scales (CAM-ICU, CRS-R, GCS and FOUR) and electroencephalography. Survivors underwent a cognitive assessment before hospital discharge with brief screening tools (MoCA and FAB scores) and a comprehensive neuropsychological assessment at 6 and 12 months after discharge.Results: We enrolled 109 patients, of which 61% had SAE during the first 48-h of the ICU stay. The most frequent clinical manifestation was fluctuation of arousal. Ten of the 52 ICU survivors that could be assessed showed persistent cognitive dysfunction at hospital discharge. Only the presence of SAE was associated with persistent cognitive dysfunction, in the whole cohort as well as in the subgroup of patients not receiving continuous sedation. At 6 months after discharge, 84% of survivors presented diffuse cognitive impairment (memory, attention, and executive functions were impaired), and high depression score. Cognitive deficit at 6 month was associated with cognitive disability at discharge, and severity of illness during ICU stay, but not with SAE. After 12 months, 82% of survivors presented cognitive difficulties in the same cognitive domains as at the 6-month follow-up. Presence of SAE or any other ICU associated variables were not associated with the severity of cognitive impairment. We found an evolution compared to middle-term assessment in broad cognition, but individual cognitive profiles were mixed.Conclusion: SAE occurs in most patients with sepsis, even in the absence of prior or concomitant causes of encephalopathy. Its detection requires testing patients for fluctuation in arousal. Also, long-term cognitive impairment and depression are observed in survivors. Therapeutics interventions to improve cognitive deficits are thus desirable, and it is also crucial to consider psychological health in those patients.