Neuropsychiatric outcomes in sepsis: A vital sign worth monitoring

Abstract

Septic shock is a state of physiological disarray that disrupts perfusion, overwhelms inflammatory control, and, as evidence now shows, compromises the structural and functional integrity of the brain. In their recent study, Li et al explored how specific hemodynamic derangements, such as reduced cardiac index, low mean arterial pressure, and elevated lactate, correlate with neuropsychiatric outcomes including delirium, depression, anxiety, and post-traumatic stress disorder. The findings reframe psychiatric symptoms not only as downstream consequences, but as measurable, clinically relevant expressions of unstable physiology. This editorial argues that neuropsychiatric outcomes in sepsis should be regarded as a vital sign worth tracking, and maybe more importantly, worth preventing. Rather than viewing altered cognition and mood as potentially unavoidable sequelae, perhaps we should begin monitoring them with the same intensity as lactate clearance and oxygen saturation. Doing so may not only preserve cognitive health, but also refine our hemodynamic goals themselves. Psychiatry, critical care, and neuroscience each have a role to play in defining this new frontier of care, one where protecting the mind begins in the intensive care unit.

Keywords: Septic shock; Delirium; Post-traumatic stress disorder; Anxiety; Depression; Hemodynamic instability; Sepsis-associated encephalopathy; Critical care; Neuroinflammation

Core Tip: Neuropsychiatric symptoms such as delirium, anxiety, and post-traumatic stress disorder in septic shock are often dismissed as secondary or unavoidable outcomes of critical illness. New data suggest that these symptoms may be real-time indicators of hemodynamic instability and cerebral hypoperfusion. This editorial argues that altered cognition and mood during septic shock should be monitored alongside traditional vital signs like mean arterial pressure and lactate.