Sepsis Associated Encephalopathy (SAE)


  • SAE is a key manifestation of sepsis occurring in up to 70% of ICU patients
  • Associated with higher ICU and hospital mortality and long term consequences
  • Difficult to assess, diagnose without specific treatment


  • SAE is probably the most common type of encephalopathy in the ICU
  • SAE may occur 36-48 hours BEFORE other systemic symptoms of sepsis.
    • Therefore, should look for sepsis in any patient who develops changes in behavior or consciousness.
  • Incidence approximated between 40-50% in sepsis patients
    • Ranges reported between 8-70%
    • Especially in patients with bacteremia
  • No consistent definition of SAE
    • Defined by a combination of extracranial infection with clinical signs of neurological dysfunction
  • Clinical Manifestations range from impairment of awareness to delirium and coma.
  • SAE is a diagnosis of exclusion
  • Mental status changes may occur 36-48 hours before other systemic symptoms of sepsis
    • Assess for sepsis in any patient with changes in behavior or consciousness


  • Molecular mechanisms leading to SAE not completely known.
    • SAE probably multifactorial (Figure)
  • Sub-divided into acute (Delirium) and chronic (Dementia) Phases
    • Acute phase changes in patient consciousness
      • Agitation, hallucinations, decreased concentration, coma.
      • Delirium correlates with development of long term cognitive dysfunction
  • Chronic phase dementia
    • No exact risk factors identified contributing to poor neurocognitive outcome
    • At discharge, between 45-62% of sepsis survivors have symptoms of long term cognitive dysfunction


  • SAE is a diagnosis of exclusion
  • Mental status changes in sepsis patients may be related to other causes than infection which should be assessed (i.e. electrolytes, vitamin deficiency, etc)
  • Ensure primary cerebral pathologies are excluded
  • Non-specific Findings:
    • Cerebrospinal fluid
    • Cerebral imaging (CT, MRI)
    • Blood chemistries (CBC, electrolytes)
  • Electroencephalograph (EEG)
    • Abnormalities documented in 50% of sepsis patients
    • Aids in assessing severity of SAE
    • Non-convulsive seizures seen in up to 20% of cases
    • EEG Grades & SAE
    • Lack of strong correlation between clinical manifestations and EEG findings
  • Screening: CAM-ICU or ICDSC is of great importance but infrequently used
  • Risk Factors for SAE:
    • Relationship between SAE & risk factors poorly related
    • Possibilities include: Age; previous cognitive impairment; kidney or Liver failure; sepsis severity


  • Patients with SAE have reported mortality rates up to 49% and greater than non-SAE sepsis patients (29%)
    • The cause of the increased mortality is not knownNo specific treatment available
  • Treat underlying sepsis
  • There is a lack of evidence supporting treatment options are effective on SAE delirium
  • Consider non-pharmacologic approaches: sleep; early mobilization; re-orientation, etc.


  • Exact incidence, prevalence and mortality of SAE is unknown due to a lack of SAE definitive criteria.
  • Probably the most common type of encephalopathy in the ICU
  • SAE is a diagnosis of exclusion

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (, or video chat.