Early Clinical, Laboratory, and Imaging Correlates of Neurological Dysfunction in Adults Presenting to the Emergency...

To characterize the prevalence and clinical profile of neurological dysfunction and pure sepsis-associated encephalopathy (SAE) in adults presenting to the emergency department (ED) with sepsis, and to identify early clinical, laboratory, and brain imaging parameters associated with these phenotypes.

This retrospective study included 226 adults with sepsis (Sepsis-3 criteria) at a tertiary emergency hospital. Neurological dysfunction was defined as an acute mental status change, and pure SAE was diagnosed after systematic exclusion of other identifiable causes of encephalopathy. Demographic, clinical, laboratory, and brain computed tomography (CT) data were collected from medical records.

Group comparisons were made using Mann-Whitney U, chi-square, or Fisher's exact tests. Multivariable binary logistic regression identified predictors of neurological dysfunction and pure SAE.

Neurological dysfunction was present in 79.6% of patients, and pure SAE in 24.8%. In the multivariate model, red cell distribution width (RDW) independently predicted pure SAE (OR 1.20, 95% CI 1.05-1.36; p = 0.005), while creatinine was inversely associated (OR 0.77, 95% CI 0.60-0.99; p = 0.038), consistent with the exclusion of patients with metabolic causes of encephalopathy from the pure SAE category. Frontal cortical atrophy on brain CT was the only imaging parameter linked to pure SAE (p = 0.022). Neurological dysfunction and pure SAE were associated with lower survival at discharge (26% vs. 67.3% and 19.6% vs. 39.4%, respectively).

Neurological dysfunction is common in ED sepsis patients. RDW and frontal cortical atrophy may help identify pure SAE early. These markers could aid rapid risk stratification and management.