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Prognostic role of urinary ketone body in patients with sepsis-associated encephalopathy without hepatic failure: a retrospective cohort study

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Abstract

Sepsis-associated encephalopathy (SAE) is defined as a dysfunction of the central nervous system experienced during sepsis with variable clinical features. The study aims to identify the prognostic role of urinary ketone bodies in relation to clinical outcomes in patients with SAE. The Medical Information Mart for Intensive Care III (MIMIC-III) database was used to conduct a retrospective cohort study. We recruited 427 patients with SAE admitted to the intensive care unit (ICU) from the MIMIC-III database. Patients with SAE were divided into a survival group (380 patients) and a non-survival group (47 patients). We used the Wilcoxon signed-rank test and the multivariate logistic regression analysis to analyze the relationship between the level of urinary ketone bodies and the clinical prognosis in patients with SAE. The primary outcome was the relationship between urinary ketone body levels and 28-day mortality of SAE. The secondary outcomes were the relationship between urinary ketone body levels and length of ICU stays, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment (SOFA), Glasgow Coma Scale, mechanical ventilation, renal replacement therapy, and the use of vasopressors. The 28-day mortality of patients with SAE was 11.0%. Urinary ketone body levels were not significantly associated with the 28-day mortality of patients with SAE. Urinary ketone body levels were associated with SOFA score and the use of vasopressors in patients with SAE. The SOFA score was an independent risk factor for the 28-day mortality in patients with SAE. Urinary ketone body levels were significantly associated with SOFA score and the use of vasopressors in patients with SAE. Furthermore, the SOFA score can predict the prognosis of short-term outcomes of patients with SAE. Therefore, we should closely monitor the changes of urinary ketone bodies and SOFA score and intervene in time.

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Availability of data and materials

The datasets analyzed during the current study are available in https://github.com/MIT-LCP/mimic-code/tree/master/concepts/severityscores.

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Acknowledgements

The authors would like to thank MIMIC III program for access to the database.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, 300100, China

    Tian Ruan, Ya Wu & Jianbo Yu

  2. Department of Anesthesiology, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, 300100, China

    Chuanning Liu, Mu Xu & Jianbo Yu

  3. Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Nankai District, Tianjin, 300100, China

    Jianbo Yu

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  1. Tian Ruan
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  2. Ya Wu
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Contributions

Tian Ruan and Jianbo Yu designed the study. Tian Ruan, Chuanning Liu, and Mu Xu collected and analyzed the data. Ya Wu supervised the data and provided statistical advices. Tian Ruan wrote the paper. Jianbo Yu reviewed the paper. All authors approved the final manuscript.

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Correspondence to Jianbo Yu.

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Ruan, T., Wu, Y., Liu, C. et al. Prognostic role of urinary ketone body in patients with sepsis-associated encephalopathy without hepatic failure: a retrospective cohort study. Intern Emerg Med (2024). https://doi.org/10.1007/s11739-024-03563-1

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