Microbiological and clinical predictors of sepsis-associated encephalopathy in bloodstream infections: a retrospective cohort study.

Abstract

Background: Sepsis-associated encephalopathy (SAE) is a common and severe complication of sepsis, significantly contributing to morbidity and mortality. The impact of specific blood-borne pathogens on SAE risk and prognosis remains unclear. This study investigates the microbiological and clinical factors associated with bloodstream infection-induced SAE.

Methods: We analyzed data from the MIMIC-IV database, including 16,141 sepsis patients who met inclusion criteria. Patients were divided into SAE and non-SAE groups for comparison. Multivariate regression identified independent risk factors for SAE and associated outcomes, including in-hospital mortality.

Results: Coagulase-negative staphylococci (CoNS) was identified as a key microbial risk factor for SAE (HR=1.919, P<0.001), though it was not associated with in-hospital mortality. Higher SOFA scores, mechanical ventilation, and prolonged antibiotic use significantly increased SAE risk. Laboratory tests revealed higher white blood cell counts, platelet levels, and metabolic abnormalities in SAE patients. Methicillin-resistant Staphylococcus aureus (MRSA) was linked to increased mortality in SAE patients (HR=3.423, P<0.001).

Conclusion: Coagulase-negative staphylococci is a significant risk factor for SAE development, but not for mortality. Advanced age, female gender, higher SOFA scores, and mechanical ventilation further contribute to SAE risk. Early identification and targeted management of pathogens, particularly methicillin-resistant Staphylococcus aureus, are crucial for improving SAE outcomes.