Mortality among patients with sepsis associated with a bispectral electroencephalography (BSEEG) score

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Sepsis (n=628). Intervention: Bispectral electroencephalography (BSEEG) score vs. Lower BSEEG score. Primary outcome: All-cause mortality (HR 1.25, 95% CI 1.06-1.48, p=0.008).

Takehiko Yamanashi; Pedro S. Marra; Kaitlyn J. Crutchley; Nadia E. Wahba; Johnny R. Malicoat; Eleanor J. Sullivan; Cade C. Akers; Catherine A. Nicholson; Felipe M. Herrmann; Matthew D. Karam; Nicolas Noiseux; Koichi Kaneko; Eri Shinozaki; Masaaki Iwata; Hyunkeun Ryan Cho; Sangil Lee; Gen Shinozaki

doi:10.1038/s41598-021-93588-9

July 9, 2021Scientific ReportsOpen Access

Mortality among patients with sepsis associated with a bispectral electroencephalography (BSEEG) score

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Key result

Higher bispectral electroencephalography (BSEEG) scores were significantly associated with increased mortality (HR 1.25), indicating its potential utility for identifying high-risk patients.

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Why the study?

A previously developed bispectral electroencephalography device detected delirium and predicted outcomes, but its application in sepsis remained to be evaluated.

Does the bispectral electroencephalography (BSEEG) score predict mortality in hospitalized patients with and without sepsis?

Study Design

Type

Cohort (n=628)

Multicenter

No

Structured PICO

Does the bispectral electroencephalography (BSEEG) score predict mortality in hospitalized patients with and without sepsis?

P

Population

628 hospitalized adults (mean age 66.6 years, 51.9% female) were retrospectively evaluated to determine the association between bispectral electroencephalography (BSEEG) scores, sepsis, and up to 365-day mortality.

E

Exposure

Bispectral electroencephalography (BSEEG) score assessment

O

Outcome

All-cause mortality at 28 days and 365 dayshard clinical

Main Result

Hazard Ratio: 1.25 (95% CI 1.06–1.48)

p-value: p=0.008

The BSEEG score is a significant independent predictor of 28-day and 365-day mortality in hospitalized patients, including those with sepsis, suggesting its potential utility for risk stratification.

Limitations

Algorithm originally designed to detect delirium, not sepsis
Definition of sepsis based on retrospective chart review without specific criteria, prone to misclassification
Cohort originally recruited for delirium studies, potentially generating bias
95.9% of patients were non-Hispanic white
Single medical center study
Definition of sepsis based on retrospective chart review of EMRs, prone to misclassification
Cohort originally recruited for delirium studies, potentially generating biased conclusion
Lack of diversity (95.9% non-Hispanic white)
Single medical center

Implication

BSEEG score was associated with mortality in sepsis; leaves open utility for risk stratification pending prospective validation.

Abstract

We have previously developed a bispectral electroencephalography (BSEEG) device, which was shown to be effective in detecting delirium and predicting patient outcomes. In this study we aimed to apply the BSEEG approach for a sepsis. This was a retrospective cohort study conducted at a single center. Sepsis-positive cases were identified based on retrospective chart review. EEG raw data and calculated BSEEG scores were obtained in the previous studies. The relationship between BSEEG scores and sepsis was analyzed, as well as the relationship among sepsis, BSEEG score, and mortality. Data were analyzed from 628 patients. The BSEEG score from the first encounter (1st BSEEG) showed a significant difference between patients with and without sepsis (p = 0.0062), although AUC was very small indicating that it is not suitable for detection purpose. Sepsis patients with high BSEEG scores showed the highest mortality, and non-sepsis patients with low BSEEG scores showed the lowest mortality. Mortality of non-sepsis patients with high BSEEG scores was as bad as that of sepsis patients with low BSEEG scores. Even adjusting for age, gender, comorbidity, and sepsis status, BSEEG remained a significant predictor of mortality (p = 0.008). These data are demonstrating its usefulness as a potential tool for identification of patients at high risk and management of sepsis.

Discussion

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Cite This Study

Yamanashi et al. (2021) conducted a cohort in Sepsis (n=628). Bispectral electroencephalography (BSEEG) score vs. Lower BSEEG score was evaluated on All-cause mortality (HR 1.25, 95% CI 1.06-1.48, p=0.008). Higher bispectral electroencephalography (BSEEG) scores were significantly associated with increased mortality (HR 1.25), indicating its potential utility for identifying high-risk patients.

synapsesocial.com/papers/6a940b9101cbad71020076ee https://doi.org/10.1038/s41598-021-93588-9

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Mortality among patients with sepsis associated with a bispectral electroencephalography (BSEEG) score

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Mortality among patients with sepsis associated with a bispectral electroencephalography (BSEEG) score

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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