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Transcranial Doppler Can Predict Development and Outcome of Sepsis-Associated Encephalopathy in Pediatrics With
HebatAllah Algebaly1, Seham ElSherbini1, Ahmed Galal2
1Pediatric Critical Care Unit, Department of Pediatrics, Cairo University, Cairo, Egypt.
Insights
Transcranial Doppler (TCD) can predict sepsis-associated encephalopathy (SAE) and mortality in critically ill children. Elevated cerebrovascular resistance, indicated by high pulsatility and resistive indices, is linked to worse outcomes in pediatric sepsis patients.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Vascular Physiology
Background:
- Sepsis is a leading cause of pediatric intensive care unit (PICU) admission.
- Sepsis-associated encephalopathy (SAE) is a common complication, potentially linked to impaired cerebral microcirculation.
- Transcranial Doppler (TCD) is a non-invasive tool to assess cerebral blood flow dynamics.
Purpose of the Study:
- To evaluate the utility of TCD in predicting SAE in children with severe sepsis or septic shock.
- To assess the role of TCD in predicting mortality among these pediatric patients.
- To investigate the relationship between cerebral microcirculation parameters and SAE outcomes.
Main Methods:
- Prospective study of 75 children admitted to the PICU for severe sepsis or septic shock.
- Clinical assessment, laboratory workup, and PRISM III score for illness severity.
- TCD measurements of pulsatility index (PI) and resistive index (RI) were performed on admission.
Main Results:
- SAE patients exhibited significantly higher PI and RI compared to non-SAE patients (p < 0.002).
- PI and RI demonstrated good predictive performance for SAE development (AUC 0.72-0.73).
- Higher PRISM III scores and elevated PI/RI were associated with mortality in SAE patients.
Conclusions:
- Children with SAE show increased cerebrovascular resistance.
- TCD-derived indices (PI and RI) are valuable predictors of SAE and mortality in critically ill children.
- Elevated cerebrovascular resistance in SAE is associated with increased mortality risk.
Abstract:
Background and Aim: Sepsis is a common cause of pediatric intensive care unit (ICU) admission. Sepsis-associated encephalopathy (SAE) may occur owing to brain dysfunction in those patients and may be related to impaired cerebral microcirculation. Transcranial Doppler (TCD) can be used to detect this impairment. In this study, we aimed to assess the role of TCD in prediction of SAE and mortality in patients with severe sepsis or septic shock admitted to PICU. Patients and Methods: This prospective study included 75 children admitted to PICU owing to severe sepsis or septic shock. Upon admission, all patients were subjected to careful history taking, thorough clinical examination, and standard laboratory workup. Severity of clinical illness was assessed using the Pediatric Risk of Mortality (PRISM) III score. TCD was performed on the first day of admission after the normalization of systolic blood pressure with or without vasopressors. The primary study outcome was differences in the measurement of TCD in SAE, and the secondary outcome was discharge from ICU or mortality. Results: The study comprised 45 children with SAE and 30 age- and sex-matched children without SAE. In this study, SAE patients had significantly higher pulsatility index [PI; median interquartile range (IQR): 1.15 (0.98-1.48) vs. 1.0 (0.95-1.06), p = 0.002] and resistive index [RI; median (IQR): 0.68 (0.61-0.77) vs. 0.62 (0.59-0.64), p = 0.001] than had non-SAE patients. PI and RI showed good performance as predictors of subsequent SAE development [area under the curve (AUC): 0.72 and 0.73, respectively]. Non-survivors in SAE patients had significantly higher PRISM III. Receiver operating characteristic (ROC) curve analysis showed good performance of PI and RI as predictors of mortality at the end of follow-up. Conclusions: In children with SAE, cerebrovascular resistance is high and is associated with increased mortality.
