Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry

Abstract Background Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and ou...

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Autores principales:	Ryuta Nakae, Tetsuro Sekine, Takashi Tagami, Yasuo Murai, Eigo Kodani, Geoffrey Warnock, Hidetaka Sato, Akio Morita, Hiroyuki Yokota, Shoji Yokobori
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Brain Atrophy Sepsis Mechanical ventilation Critical care outcomes Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/037e73ce67cc4adb83e28bc20c58ea4a
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spelling	oai:doaj.org-article:037e73ce67cc4adb83e28bc20c58ea4a2021-12-05T12:03:48ZRapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry10.1186/s13054-021-03828-71364-8535https://doaj.org/article/037e73ce67cc4adb83e28bc20c58ea4a2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13054-021-03828-7https://doaj.org/toc/1364-8535Abstract Background Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and outcomes. Methods Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included (n = 48). The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the “brain atrophy group (n = 42)”, and those with ≥ 0% were defined as the “no brain atrophy group (n = 6).” Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups. Results Analysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. second CT scan: 1.002 ± 0.121 L, t (41) = 9.436, p < 0.001). The mean percentage change in brain volume between CT scans in the brain atrophy group was –3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm3. The proportion of cases on mechanical ventilation (95.2% vs. 66.7%; p = 0.02) and median time on mechanical ventilation (28 [IQR 15–57] days vs. 15 [IQR 0–25] days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group. Conclusions Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation.Ryuta NakaeTetsuro SekineTakashi TagamiYasuo MuraiEigo KodaniGeoffrey WarnockHidetaka SatoAkio MoritaHiroyuki YokotaShoji YokoboriBMCarticleBrainAtrophySepsisMechanical ventilationCritical care outcomesMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care, Vol 25, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Brain Atrophy Sepsis Mechanical ventilation Critical care outcomes Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Brain Atrophy Sepsis Mechanical ventilation Critical care outcomes Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Ryuta Nakae Tetsuro Sekine Takashi Tagami Yasuo Murai Eigo Kodani Geoffrey Warnock Hidetaka Sato Akio Morita Hiroyuki Yokota Shoji Yokobori Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry
description	Abstract Background Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and outcomes. Methods Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included (n = 48). The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the “brain atrophy group (n = 42)”, and those with ≥ 0% were defined as the “no brain atrophy group (n = 6).” Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups. Results Analysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. second CT scan: 1.002 ± 0.121 L, t (41) = 9.436, p < 0.001). The mean percentage change in brain volume between CT scans in the brain atrophy group was –3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm3. The proportion of cases on mechanical ventilation (95.2% vs. 66.7%; p = 0.02) and median time on mechanical ventilation (28 [IQR 15–57] days vs. 15 [IQR 0–25] days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group. Conclusions Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation.
format	article
author	Ryuta Nakae Tetsuro Sekine Takashi Tagami Yasuo Murai Eigo Kodani Geoffrey Warnock Hidetaka Sato Akio Morita Hiroyuki Yokota Shoji Yokobori
author_facet	Ryuta Nakae Tetsuro Sekine Takashi Tagami Yasuo Murai Eigo Kodani Geoffrey Warnock Hidetaka Sato Akio Morita Hiroyuki Yokota Shoji Yokobori
author_sort	Ryuta Nakae
title	Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry
title_short	Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry
title_full	Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry
title_fullStr	Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry
title_full_unstemmed	Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry
title_sort	rapidly progressive brain atrophy in septic icu patients: a retrospective descriptive study using semiautomatic ct volumetry
publisher	BMC
publishDate	2021
url	https://doaj.org/article/037e73ce67cc4adb83e28bc20c58ea4a
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Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry

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