BACKGROUND

Sepsis-associated encephalopathy (SAE) is an acute neurological dysfunction following sepsis. Multimodal evoked potentials (EP_s) as an option of neurophysiological monitoring available in critically ill patients demonstrate functional brain damage.

OBJECTIVE

To evaluate diagnostic role of multimodal EP_s in initial signs of SAE for establishing the appropriate treatment recommendations.

MATERIALS AND METHODS

There were 25 critically ill patients on the 1st day after diagnosis of sepsis or septic shock according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Evoked potentials were assessed according to standard protocols. We considered abnormal deviations of latency, inter-peak intervals and amplitudes.

RESULTS

Peak latent periods were significantly increased in patients with sepsis compared to the control group. SSEP_s subcortical tracts were disrupted in 90% of patients, cortical SSEP_s tracts — in 40% of patients. Brainstem auditory evoked potentials had a lower amplitude (p=0.023) and increased inter-peak intervals in patients with sepsis compared to the control group. These findings indicated disruption of functional connections at the level of brainstem. We found no significant differences in visual evoked potentials. ROC analysis revealed the following informative components of SSEP_s: N20 latency (AUC 0.720; p=0.052); N13-N20 interval (AUC 0.850; p=0.012). Analysis of brainstem auditory evoked potentials found that amplitude I and interval III-V showed the largest AUC (0.777; p=0.007).

CONCLUSION

These data indicate early changes of SSEP_s following acute sepsis-induced cerebral damage. Septic encephalopathy without early clinical manifestations is more common than it seems. Severity of acute cerebral dysfunction correlates with severity of systemic disease.