Clinical value of Lindegaard in the early diagnosis of sepsis-associated encephalopathy

doi:10.3969/j.issn.1006-7795.2023.06.009

Abstract

Abstract: Objective To investigate the clinical value of Lindegaard index (LR) in early diagnosis of sepsis-associated encephalopathy (SAE). Methods A retrospective analysis was performed on sepsis patients admitted to the Emergency Department of Beijing Chaoyang Hospital, Capital Medical University, from November 2021 to March 2022. Clinical data were collected during 24 h after admission. Within three days after the diagnosis of sepsis, the SAE was diagnosed with diagnostic gold standard: the positive confusion assessment method for the intensive care unit (CAM-ICU) evaluation or persistent Glasgow coma score (GCS) ≤ 14.Patients were divided into the SAE group and the non-SAE group. The differences in ultrasound parameters of the middle cerebral artery (MCA) including systolic velocity (Vs), diastolic velocity (Vd), mean velocity (Vm), pulsatility index (PI), resistant index (RI), LR on the first and third day of admission were analyzed between the two groups. Logistic regression was used to analyze the risk factors of early SAE in patients with sepsis. The receiver operating characteristic (ROC) curve was plotted to assess the predictive value of each risk factor for SAE. Results Thirty-seven patients with sepsis were included in this study, with 17 in the SAE group and 20 in the non-SAE group. The 28-day mortality and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, GCS, blood lactate, incidence of cerebral vasospasm within 24 h of admission were significantly higher in the SAE group than those in the non-SAE group (P<0.05). On the first day (D1), VsD1, VdD1, VmD1, and LRD1 in the SAE group were significantly higher than those in the non-SAE group (P<0.05). There were no significant differences in those ultrasound parameters between the SAE group and the non-SAE group on the third day. On the third day (D3), VsD3, VdD3, VmD3, and LRD3 in the SAE group were significantly lower compared to the first day (P<0.05). ΔLR (LRD1－LRD3) in the SAE group was significantly higher than that in the non-SAE group (P<0.05). Logistic regression analysis showed that the APACHE Ⅱ score within 24 h of admission, LRD1 and ΔLR were risk factors for SAE. ROC analysis showed that the area under the curve (AUC) of APACHE Ⅱ score within 24 h of admission, LRD1, ΔLR and APACHE Ⅱ score combined with ΔLR predicting SAE were 0.94, 0.86, 0.77 and 0.96 respectively, with P<0.05. The cut-off value of LRD1 for diagnosing SAE was 2.6, the sensitivity was 76.47%, and the specificity was 95.00%. The APACHE Ⅱ combined with ΔLR had the best diagnostic efficacy for SAE (AUC=0.96,95% CI： 0.85－0.99, P<0.05), with a sensitivity of 88.24% and a specificity of 95.00%. Conclusion The APACHE Ⅱ score within 24 h of admission, LRD1, ΔLR are all valuable in predicting the occurrence of early SAE. The APACHE Ⅱ score combined with ΔLR demonstrates the best diagnostic significance of SAE. The bedside ultrasound can dynamically obtain LR in patients with sepsis, which has great predictive value of early SAE.

Key words: sepsis, sepsis-associated encephalopathy, bedside ultrasound, Lindegaard index

CLC Number:

R445

Song Qian, Zhou Qian, Sun Hong, Li Shuo, Mei Xue, Guo Ruijun, Ge Huiyu. Clinical value of Lindegaard in the early diagnosis of sepsis-associated encephalopathy[J]. Journal of Capital Medical University, 2023, 44(6): 959-965.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2023.06.009

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2023/V44/I6/959

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