Daily Sepsis Research Analysis
A retrospective ED cohort study found that 20% of infected patients presented with altered mental status (AMS), which was associated with a markedly higher in-hospital mortality (15% vs 4%). Older age, cerebrovascular disease, dementia, mental disorders, bacteremia, and higher SOFA score independently predicted AMS, underscoring the need to integrate mental status into early risk stratification.
Summary
A retrospective ED cohort study found that 20% of infected patients presented with altered mental status (AMS), which was associated with a markedly higher in-hospital mortality (15% vs 4%). Older age, cerebrovascular disease, dementia, mental disorders, bacteremia, and higher SOFA score independently predicted AMS, underscoring the need to integrate mental status into early risk stratification.
Research Themes
- Neurologic presentation of infection
- Emergency department risk stratification
- Prognostic indicators linked to mental status
Selected Articles
1. Prevalence and clinical implications of altered mental status in patients with infection presenting to the emergency department.
In a consecutive ED cohort of 767 infected patients, 20% presented with altered mental status, which was associated with higher in-hospital mortality (15% vs 4%). Multivariable analysis identified age, cerebrovascular disease, dementia, mental disorders, bacteremia, and higher SOFA score as independent predictors of AMS at presentation.
Impact: This study quantifies the burden and prognostic impact of altered mental status in infected ED patients and delineates independent predictors, informing triage and early management strategies.
Clinical Implications: Mental status assessment should be treated as a core vital sign in infected ED patients. Presence of AMS should prompt expedited sepsis workup, closer monitoring, and consideration of higher level of care, especially in older adults and those with cerebrovascular disease, dementia, or bacteremia.
Key Findings
- Among 767 infected ED patients, 20% presented with altered mental status.
- In-hospital mortality was higher with AMS versus no AMS (15% vs 4%; P<0.001).
- Independent predictors of AMS included older age (OR 1.04 per year; 95% CI 1.02–1.06), cerebrovascular disease (OR 2.52; 95% CI 1.45–4.36), dementia (OR 3.57; 95% CI 2.04–6.23), mental disorders (OR 3.90; 95% CI 1.17–13.00), bacteremia (OR 2.49; 95% CI 1.39–4.46), and higher SOFA score (OR 1.31 per point; 95% CI 1.20–1.42).
Methodological Strengths
- Consecutive ED cohort with clearly defined inclusion (infected patients with blood cultures) over a fixed time window.
- Multivariable logistic regression identifying independent associations and evaluation of a clinically meaningful outcome (in-hospital mortality).
Limitations
- Retrospective design over a limited time window, with potential residual confounding and possible misclassification of altered mental status at presentation.
- Restriction to patients who had blood cultures drawn may introduce selection bias and limit generalizability; outcomes were confined to in-hospital mortality without longer-term follow-up.
Future Directions: Prospective, multicenter studies using standardized mental status assessments should validate these findings and test whether AMS-triggered care pathways improve outcomes in infected and septic patients.
The prevalence and clinical implications of altered mental status among patients presenting with infection to the emergency department (ED) remain unclear. This retrospective cohort study, which enrolled consecutive patients with infection aged ≥ 15 years who presented to the ED between January and June 2024 and underwent blood culture collection, was aimed at determining the prevalence of altered mental status, identifying associated clinical factors, and assessing its impact on mortality outcomes. Patients were stratified according to the presence or absence of altered mental status at ED presentation. Clinical characteristics were compared between groups and multivariable logistic regression analysis was performed to identify factors independently associated with altered mental status. Of the 767 patients included, 152 (20%) presented with altered mental status. In-hospital mortality was significantly higher in this group than in the control group (15 vs. 4%; P < 0.001). Multivariable logistic regression analysis identified the following independent predictors of altered mental status: advanced age [odds ratio (OR), 1.04; 95% confidence interval (CI), 1.02-1.06], history of cerebrovascular disease (OR, 2.52; 95% CI 1.45-4.36), dementia (OR, 3.57; 95% CI 2.04-6.23), mental disorders (OR, 3.90; 95% CI 1.17-13.00), bacteremia (OR, 2.49; 95% CI 1.39-4.46), and higher Sequential Organ Failure Assessment scores (OR, 1.31; 95% CI 1.20-1.42). Altered mental status is common among ED patients with infection, reflecting both infection severity and baseline patient vulnerability. Its association with increased in-hospital mortality highlights the importance of early recognition and comprehensive assessment of mental status changes in this patient population.