Sepsis-related brain MRI abnormalities are associated with mortality and poor neurological outcome in pediatric sepsis

Andrew E. Becker, Sara R. Teixeira, Nicholas A. Lunig, Antara Mondal, Julie C. Fitzgerald, Alexis A. Topjian, Scott L. Weiss, Heather Griffis, Stephanie E. Schramm, Danielle M. Traynor, Arastoo Vossough, Matthew P. Kirschen, Sepsis-Related Brain MRI Abnormalities Are Associated With Mortality and Poor Neurological Outcome in Pediatric Sepsis, Pediatric Neurology, Volume 128, 2022, Pages 1-8, https://doi.org/10.1016/j.pediatrneurol.2021.12.001 

ABSTRACT 

Objective 

To (1) determine the prevalence and type of sepsis-related neuroimaging abnormalities evident on clinically-indicated brain magnetic resonance imaging (MRI) in children with sepsis and (2) test the association of these abnormalities with mortality, new disability, length of stay (LOS), and MRI indication. 

Design 

Retrospective cohort study. 

Setting 

Single, large academic pediatric intensive care unit (PICU). 

Patients 

Pediatric patients with sepsis between 1/1/2012 and 6/30/2018 with a clinically-indicated brain MRI obtained within 60 days of sepsis onset. 

Measurements and Results 

Two radiologists systematically reviewed the first post-sepsis brain MRI and determined which abnormalities were sepsis-related by consensus. Standard descriptive statistics were used to compare outcomes of PICU mortality, new disability, and PICU LOS in patients with versus without sepsis-related MRI abnormalities. 140 patients underwent clinically-indicated brain MRI within 60 days of sepsis onset. PICU mortality was 7%. Thirty patients had ≥1 sepsis-related MRI abnormality yielding a prevalence of 21% (95% CI 15%, 28%). Among those patients, 53% (16/30) had sepsis-related white matter signal abnormalities, 53% (16/30) sepsis-related ischemia, infarction, or thrombosis and 27% (8/30) sepsis-related posterior reversible encephalopathy. Patients with ≥1 sepsis-related MRI abnormality had increased mortality (17% vs 5%; p=0.04), new neurologic disability at PICU discharge (32% vs 11%; p=0.03) and longer PICU LOS (median 18 vs 11 days; p=0.04) compared to patients without sepsis-related MRI abnormalities. 

Conclusions 

In children with sepsis and a clinically-indicated brain MRI, twenty-one percent had a sepsis-related MRI abnormality. Sepsis-related MRI abnormalities were associated with increased mortality, new neurologic disability, and longer PICU LOS. 

Courtesy of:  https://www.mdlinx.com/journal-summary/sepsis-related-brain-mri-abnormalities-are-associated-with-mortality-and-poor-neurologic-outcome-in/2IAdekDK5Pa07jKESH4t5F