J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 7, Number 7, July 2015, pages 534-539

Early Prediction and Outcome of Septic Encephalopathy in Acute Stroke Patients With Nosocomial Coma

Figure 1. Kaplan-Meier survival curves for acute stroke patients with nosocomal coma with or without SE.

**Table 1.** Characteristics of NC in Stroke Patients With and Without SE
Episodes	NC with SE (N = 46)	NC without SE (N = 48)	P
NC: nosocomial coma; SE: septic encephalopathy; ONCT: onset-to-NC time; mRS: Rankin scale.
Female gender (%)	31/15	30/18	0.619
Age (years, mean ± SD)	61.5 ± 11.2	59.6 ± 12.5	0.431
Primary intracerebral hemorrhage (%)	24 (52.2)	27 (56.3)	0.692
Striato-capsula (%)	12 (50.0)	16 (59.3)	0.443
Lobar (%)	7 (29.2)	8 (29.6)	0.848
Thalamus (%)	2 (8.3)	2 (7.4)	0.088
Brain stem (%)	3 (12.5)	1 (3.7)	0.287
Intraventricular extension (%)	8 (33.3)	10 (37.0)	0.672
Hematoma volume (mL)	17.6 ± 12.9	31.6 ± 20.7	0.007
Infarction (%)	19 (41.3)	13 (27.1)	0.146
Cardioembolic stroke (%)	1 (5.3)	1 (7.7)	0.780
Atherothrombotic (%)	10 (52.6)	9 (69.2)	0.348
Lacunar stroke (%)	7 (36.8)	3 (23.1)	0.409
Other (%)	1 (5.3)	0 (0.0)	0.401
Cerebral infarcts volume (mL)	18.4 ± 63.5	78.9 ± 98.0	0.042
Subarachnoid hemorrhage (%)	3 (6.5)	8 (16.7)	0.126
Underlying diseases
Hypertension (%)	23 (50.0)	31 (64.6)	0.153
Atrial fibrillation (%)	3 (6.5)	2 (4.2)	0.611
Diabetes (%)	2 (4.3)	5 (10.4)	0.263
Conditions of NNC
Median ONCT (days, range)	3.7 (19.0)	1.5 (41.0)	0.002
Central brain herniation (%)	27 (58.7)	28 (58.3)	0.972
Uncal herniation (%)	5 (10.9)	9 (18.8)	0.283
Mechanical ventilation (%)	29 (63.0)	25 (52.1)	0.304
Length of ICU and hospital stay (days)	11.4 ± 12.7	11.9 ± 11.8	0.850
mRS score, mean ± SD	5.1 ± 1.6	4.9 ± 1.6	0.650
Mortality in 30 days (%)	35 (76.1)	22 (45.8)	0.003

Table 1. Characteristics of NC in Stroke Patients With and Without SE

Episodes

NC with SE (N = 46)

NC without SE (N = 48)

NC: nosocomial coma; SE: septic encephalopathy; ONCT: onset-to-NC time; mRS: Rankin scale.

Female gender (%)

31/15

30/18

0.619

Age (years, mean ± SD)

61.5 ± 11.2

59.6 ± 12.5

0.431

Primary intracerebral hemorrhage (%)

24 (52.2)

27 (56.3)

0.692

Striato-capsula (%)

12 (50.0)

16 (59.3)

0.443

Lobar (%)

7 (29.2)

8 (29.6)

0.848

Thalamus (%)

2 (8.3)

2 (7.4)

0.088

Brain stem (%)

3 (12.5)

1 (3.7)

0.287

Intraventricular extension (%)

8 (33.3)

10 (37.0)

0.672

Hematoma volume (mL)

17.6 ± 12.9

31.6 ± 20.7

0.007

Infarction (%)

19 (41.3)

13 (27.1)

0.146

Cardioembolic stroke (%)

1 (5.3)

1 (7.7)

0.780

Atherothrombotic (%)

10 (52.6)

9 (69.2)

0.348

Lacunar stroke (%)

7 (36.8)

3 (23.1)

0.409

Other (%)

1 (5.3)

0 (0.0)

0.401

Cerebral infarcts volume (mL)

18.4 ± 63.5

78.9 ± 98.0

0.042

Subarachnoid hemorrhage (%)

3 (6.5)

8 (16.7)

0.126

Underlying diseases

Hypertension (%)

23 (50.0)

31 (64.6)

0.153

Atrial fibrillation (%)

3 (6.5)

2 (4.2)

0.611

Diabetes (%)

2 (4.3)

5 (10.4)

0.263

Conditions of NNC

Median ONCT (days, range)

3.7 (19.0)

1.5 (41.0)

0.002

Central brain herniation (%)

27 (58.7)

28 (58.3)

0.972

Uncal herniation (%)

5 (10.9)

9 (18.8)

0.283

Mechanical ventilation (%)

29 (63.0)

25 (52.1)

0.304

Length of ICU and hospital stay (days)

11.4 ± 12.7

11.9 ± 11.8

0.850

mRS score, mean ± SD

5.1 ± 1.6

4.9 ± 1.6

0.650

Mortality in 30 days (%)

35 (76.1)

22 (45.8)

0.003

**Table 2.** Univariate Analyses of NC in Stroke Patients With and Without SE
Episodes	NC with SE (N = 46)	NC without SE (N = 48)	P
NC: nosocomial coma; SE: septic encephalopathy; SBP: systolic blood pressure; DBP: diastolic blood pressure; GCS: Glasgow coma scale; SOFA: sequential organ failure assessment. *The patients with SIRS without infection.
Body temperature ≥ 39 °C (%)	34 (73.9)	3 (6.3)	0.000
Heart rate (beats/min)	109.5 ± 16.7	88.5 ± 19.9	0.000
Respiratory rate (breaths/min)	27.9 ± 6.4	22.5 ± 5.1	0.000
leukocyte count (× 10⁹/L)	14.9 ± 4.6	11.2 ± 6.0	0.000
Platelet count (× 10⁹/L)	220.3 ± 40.3	219.9 ± 30.6	0.966
SBP, mm Hg, mean ± SD	148.3 ± 47.3	168.6 ± 46.9	0.039
DBP, mm Hg, mean ± SD	81.6 ± 25.8	99.8 ± 30.9	0.023
Initial GCS, mean ± SD	10.2 ± 1.4	10.1 ± 1.4	0.894
Severe SIRS (%)	46 (100.0)	3 (6.3)*	0.000
Acute respiratory failure (%)	18 (39.1)	6 (12.5)	0.003
Septic shock (%)	8 (17.4)	0 (0.0)	0.003
Acute renal failure (%)	12 (26.1)	8 (16.7)	0.265
Acute hepatic failure (%)	2 (4.3)	1 (2.0)	0.532
Hyperglycemia, mean ± SD	6.55 ± 2.34	6.81 ± 2.91	0.685
Hypernatremia (> 150 mmo1/L)	7 (15.2)	1 (2.0)	0.016
Hyponatremia (< 110 mmol/L)	0 (0.0)	1 (2.0)	0.325
Acute seizures (%)	3 (6.5)	4 (8.3)	0.738
SOFA, mean ± SD	4.8 ± 2.7	2.5 ± 1.9	0.000
Repeat CT scan or MRI
Vasogenic brain edema (%)	24 (52.2)	6 (12.5)	0.000
Subcortical whiter matter lesion (%)	10 (21.7)	2 (4.2)	0.011
Diffuse cerebral swelling (%)	32 (69.6)	40 (83.3)	0.115
Thalamus compression/central herniation (%)	33 (71.7)	32 (66.7)	0.595
Midbrain compression/uncal herniation (%)	5 (10.9)	9 (18.8)	0.238
Hematoma growth (%)	1 (2.2)	23 (47.9)	0.000
Infarction progress (%)	2 (4.3)	11 (22.9)	0.009
Recurrent SAH (%)	0 (0.0)	6 (12.5)	0.011
Hemorrhagic transformation (%)	0 (0.0)	2 (4.2)	0.162

Table 2. Univariate Analyses of NC in Stroke Patients With and Without SE

Episodes

NC with SE (N = 46)

NC without SE (N = 48)

NC: nosocomial coma; SE: septic encephalopathy; SBP: systolic blood pressure; DBP: diastolic blood pressure; GCS: Glasgow coma scale; SOFA: sequential organ failure assessment. *The patients with SIRS without infection.

Body temperature ≥ 39 °C (%)

34 (73.9)

3 (6.3)

0.000

Heart rate (beats/min)

109.5 ± 16.7

88.5 ± 19.9

0.000

Respiratory rate (breaths/min)

27.9 ± 6.4

22.5 ± 5.1

0.000

leukocyte count (× 10⁹/L)

14.9 ± 4.6

11.2 ± 6.0

0.000

Platelet count (× 10⁹/L)

220.3 ± 40.3

219.9 ± 30.6

0.966

SBP, mm Hg, mean ± SD

148.3 ± 47.3

168.6 ± 46.9

0.039

DBP, mm Hg, mean ± SD

81.6 ± 25.8

99.8 ± 30.9

0.023

Initial GCS, mean ± SD

10.2 ± 1.4

10.1 ± 1.4

0.894

Severe SIRS (%)

46 (100.0)

3 (6.3)*

0.000

Acute respiratory failure (%)

18 (39.1)

6 (12.5)

0.003

Septic shock (%)

8 (17.4)

0 (0.0)

0.003

Acute renal failure (%)

12 (26.1)

8 (16.7)

0.265

Acute hepatic failure (%)

2 (4.3)

1 (2.0)

0.532

Hyperglycemia, mean ± SD

6.55 ± 2.34

6.81 ± 2.91

0.685

Hypernatremia (> 150 mmo1/L)

7 (15.2)

1 (2.0)

0.016

Hyponatremia (< 110 mmol/L)

0 (0.0)

1 (2.0)

0.325

Acute seizures (%)

3 (6.5)

4 (8.3)

0.738

SOFA, mean ± SD

4.8 ± 2.7

2.5 ± 1.9

0.000

Repeat CT scan or MRI

Vasogenic brain edema (%)

24 (52.2)

6 (12.5)

0.000

Subcortical whiter matter lesion (%)

10 (21.7)

2 (4.2)

0.011

Diffuse cerebral swelling (%)

32 (69.6)

40 (83.3)

0.115

Thalamus compression/central herniation (%)

33 (71.7)

32 (66.7)

0.595

Midbrain compression/uncal herniation (%)

5 (10.9)

9 (18.8)

0.238

Hematoma growth (%)

1 (2.2)

23 (47.9)

0.000

Infarction progress (%)

2 (4.3)

11 (22.9)

0.009

Recurrent SAH (%)

0 (0.0)

6 (12.5)

0.011

Hemorrhagic transformation (%)

0 (0.0)

2 (4.2)

0.162

**Table 3.** Multivariate Odds Ratios for SE in Acute Stroke
Episodes	OR	95% CI	P
SE: septic encephalopathy; SIRS: systemic inflammatory response syndrome; OR: odds ratio; CI: confidence intervals.
Fever (≥ 39 °C)	2.753	1.116 - 6.794	0.028
SIRS (≥ 3 items)	6.459	2.050 - 20.351	0.001

Table 3. Multivariate Odds Ratios for SE in Acute Stroke

Episodes

95% CI

SE: septic encephalopathy; SIRS: systemic inflammatory response syndrome; OR: odds ratio; CI: confidence intervals.

Fever (≥ 39 °C)

2.753

1.116 - 6.794

0.028

SIRS (≥ 3 items)

6.459

2.050 - 20.351

0.001