Neuropsychiatric symptoms in the context of hemodynamic disruption during septic shock

Table 1 Baseline characteristics analysis

Characteristic	Sepsis group (n = 86)	Septic shock group (n = 46)	P value
Demographic characteristics
Age (years)	58.5 ± 12.3	60.2 ± 11.7	0.456
Gender
Male	56 (65.1)	31 (67.4)	0.789
Female	30 (34.9)	15 (32.6)
Body mass index (kg/m²)	26.4 ± 4.5	26.8 ± 4.2	0.678
Comorbidities
Hypertension	30 (35.0)	19 (41.3)	0.345
Diabetes	18 (20.9)	11 (23.9)	0.678
Chronic lung disease	12 (14.0)	7 (15.2)	0.856
Clinical characteristics
SOFA score	5.2 ± 1.5	7.8 ± 1.8	< 0.001
APACHE II score	15.4 ± 3.2	18.5 ± 3.5	< 0.001
Initial lactate (mmol/L)	2.1 ± 0.8	4.5 ± 1.2	< 0.001
Hemodynamic monitoring
Mean arterial pressure (mmHg)	85.2 ± 10.3	68.5 ± 11.4	< 0.001
Cardiac output (L/min)	5.1 ± 1.2	4.8 ± 1.3	0.234
Neuropsychiatric assessment
Glasgow coma scale score	14.5 ± 1.2	13.2 ± 1.5	< 0.001
Delirium occurrence	22 (25.6)	19 (41.3)	0.034

Data are presented as n (%) or mean ± SD. SOFA: Sequential Organ Failure Assessment.

Table 2 Analysis of hemodynamic parameters

Hemodynamic parameter	Sepsis group (n = 86)	Septic shock group (n = 46)	P value
Cardiac output (L/min)	5.1 ± 1.2	4.2 ± 1.0	< 0.001
Cardiac index (L/min/m²)	2.8 ± 0.6	2.3 ± 0.5	< 0.001
Pulmonary vascular permeability index	2.1 ± 0.5	3.2 ± 0.7	< 0.001
Mean arterial pressure (mmHg)	85.2 ± 10.3	63.5 ± 8.2	< 0.001
Vasopressor support	13 (15.1)	39 (84.8)	< 0.001
Lactate levels (mmol/L)	2.1 ± 0.8	4.5 ± 1.2	< 0.001
Venous oxygen saturation (SvO2, %)	68.5 ± 5.2	62.1 ± 6.3	< 0.001
Systemic vascular resistance (dyn·s/cm5)	1200 ± 300	1500 ± 400	< 0.001
Pulmonary artery wedge pressure (mmHg)	10.2 ± 2.1	12.5 ± 3.0	< 0.001
Stroke volume (mL)	70.5 ± 15.0	60.0 ± 12.0	< 0.001
Mixed venous oxygen saturation (SvO2, %)	72.0 ± 6.0	65.0 ± 7.0	< 0.001
Mixed venous oxygen Saturation (SvO2, %)	72.0 ± 6.0	65.0 ± 7.0	< 0.001

Data are presented as n (%) or mean ± SD.

Table 3 Prevalence and characteristics of neuropsychiatric manifestations

Neuropsychiatric manifestation	Sepsis group (n = 86)	Septic shock group (n = 46)	P value
Delirium occurrence	26 (30.2)	18 (39.1)	0.034
Anxiety	22 (25.6)	16 (34.8)	0.123
Depression	22 (25.6)	16 (34.8)	0.123
Posttraumatic stress disorder	13 (15.1)	12 (26.1)	0.045
Symptom duration (days)	5.2 ± 2.1	7.8 ± 3.2	< 0.001
Glasgow coma scale score	14.5 ± 1.2	13.2 ± 1.5	< 0.001
Hospital anxiety and depression scale score	7.2 ± 2.1	8.5 ± 2.5	0.012
Pittsburgh sleep quality index score	5.0 ± 1.5	6.0 ± 1.8	0.023
Cognitive impairment	11 (12.8)	10 (21.7)	0.156

Data are presented as n (%) or mean ± SD.

Table 4 Inflammatory factors and neurotransmitter profiles

Parameter	Sepsis group (n = 86)	Septic shock group (n = 46)	P value
Inflammatory factors
IL-6 (pg/mL)	125.4 ± 30.2	250.8 ± 50.4	< 0.001
TNF-α (pg/mL)	85.6 ± 15.2	150.2 ± 25.3	< 0.001
hs-CRP (mg/L)	45.3 ± 10.2	80.5 ± 15.1	< 0.001
IL-1β (pg/mL)	20.5 ± 5.1	35.2 ± 7.3	< 0.001
Neurotransmitter levels
Serotonin (ng/mL)	150.2 ± 20.3	120.5 ± 18.2	< 0.001
Dopamine (ng/mL)	80.5 ± 12.3	60.2 ± 10.5	< 0.001
Norepinephrine (ng/mL)	60.3 ± 8.5	45.2 ± 7.8	< 0.001
Glutamate (µM)	10.5 ± 1.5	12.8 ± 2.0	< 0.001
GABA (µM)	8.2 ± 1.2	6.5 ± 1.0	< 0.001

Data are presented as mean ± SD. IL: Interleukin; TNF-α: Tumor necrosis factor-alpha; hs-CRP: High-sensitivity C-reactive protein; GABA: Gamma-aminobutyric acid.

Table 5 Correlation analysis findings

Hemodynamic indicator	Neuropsychiatric symptom	Pearson correlation (r)	Spearman correlation (ρ)	P value
Cardiac output (L/min)	Delirium risk	-0.456	-0.489	< 0.05
Tissue perfusion (SvO2, %)	Delirium risk	-0.398	-0.421	< 0.05
Lactate levels (mmol/L)	Anxiety severity	0.523	0.556	< 0.05
Lactate levels (mmol/L)	Depression severity	0.487	0.512	< 0.05
Mean arterial Pressure (mmHg)	Cognitive impairment	-0.350	-0.375	< 0.05
Systemic vascular resistance (dyn·s/cm5)	Posttraumatic stress disorder severity	0.400	0.425	< 0.05
Pulmonary artery wedge pressure (mmHg)	Sleep quality	-0.380	-0.405	< 0.05
Stroke volume (mL)	Cognitive impairment	-0.420	-0.450	< 0.05
Mixed venous oxygen saturation (SvO2, %)	Overall neuropsychiatric symptom severity	-0.480	-0.510	< 0.05

Table 6 Survival analysis outcomes

Indicator	Survival analysis	Log-rank test	P value
Neuropsychiatric symptom severity	Reduced survival rates in septic shock patients with severe symptoms	Significant correlation with prognosis	< 0.05
Persistent hypotension	Increased 28-day mortality rates	Significant correlation with prognosis	< 0.05
Elevated lactate levels	Increased 28-day mortality rates	Significant correlation with prognosis	< 0.05
Cardiac index (L/min/m²)	Reduced survival rates with lower cardiac index	Significant correlation with prognosis	< 0.05
Mean arterial pressure (mmHg)	Reduced survival rates with lower mean arterial pressure	Significant correlation with prognosis	< 0.05
Systemic vascular resistance (dyn·s/cm5)	Increased mortality rates with higher systemic vascular resistance	Significant correlation with prognosis	< 0.05
Pulmonary artery wedge pressure (mmHg)	Increased mortality rates with higher pulmonary artery wedge pressure	Significant correlation with prognosis	< 0.05
Stroke volume (mL)	Reduced survival rates with lower stroke volume	Significant correlation with prognosis	< 0.05
Mixed venous oxygen saturation (SvO2, %)	Reduced survival rates with lower SvO2	Significant correlation with prognosis	< 0.05