Robertus H.C. Bisschops, Presenter: Nothing to Disclose

Bianca Mooi MS, Abstract Co-Author: Nothing to Disclose

Jan-Willem C. Gratama, Abstract Co-Author: Nothing to Disclose

Carel Bendien MD, PhD, Abstract Co-Author: Nothing to Disclose

Peter E Spronk, Abstract Co-Author: Nothing to Disclose

Johannes H. Rommes, Abstract Co-Author: Nothing to Disclose

Surviving severe sepsis is associated with long term cognitive impairment. Imaging studies revealed structural, partly reversible brain damage in the course of severe sepsis. The aim of this study is to assess cognitive dysfunction outcome and brain morphology in survivors of severe sepsis

Between January 2002 and January 2005 we included 43 severe sepsis survivors (APACHE II score >18, age 48 hours and >24 hours mechanical ventilation). Patients with premorbid cognitive disability, chronic, cerebrovascular and atherosclerotic disease were excluded (n=29). All patients underwent neuropsychologically evaluation. Cognitive impairment was considered if ≥3 out 10 tests scored >1.5 SD below norm-reference. MRI (1.5T) brain imaging included a T1, T2 and a T2-FLAIR. All images were analyzed for white matter lesions (WML), infarcts, and brain atrophy, using the bicaudate ratio (BCR) and the Sylvian fissure width. Semi-quantitative brain atrophy analysis was performed using a sulcal and ventricular grading scale. MRI brain scans of 42 age, health and gender matched individuals served as controls. Fisher’s exact and Kruskal-Wallis analysis were performed where applicable.

Fourteen patients (mean age 54±11years, 7F:7M) were analyzed. Median (IQR) APACHE II score was 26 (22-28), ICU stay 20 (15-38) days. Time between ICU discharge and MRI was 35 (25-39) months. Four (28%) severe sepsis survivors were cognitive impaired. Territorial infarcts were observed in one (7%) and WML in ten (65%) severe sepsis survivors (n.s compared with controls). Severe sepsis survivors had an increased BCR 0.54 (0.49-0.57) vs. 0.43 (0.40-0.50), p<0.001 and ventricular grades 3 (2-6) vs. 2 (1-2), p<0.01 compared to healthy individuals. BCR tended to be increased in cognitive impaired severe sepsis survivors compared to those with normal cognitive function, 0.57 (0.55-0.60) vs. 0.50 (0.45-0.56), p<0.07.

Cognitive impairment and increased central brain atrophy is prevalent among survivors of severe sepsis

Surviving severe sepsis is associated with central brain atrophy and long term neuropsychological sequelae that interfere with the quality of life.

Bisschops, R, Mooi, B, Gratama, J, Bendien, C, Spronk, P, Rommes, J, Significant Brain Atrophy on MRI and Cognitive Dysfunction in Long-term Severe Sepsis Survivors.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4438934.html