Frequency, natural history, & etiology of retinal lesions (RL) in ICU patients with sepsis

The frequency & natural history of retinal findings in ICU patients were examined by correlating retinal findings with admitting diagnosis, intercurrent events, and septicemta. Starting within 7 d of ICU admission, patients (pts) having a projected stay > 3 d and APACHE II score (AP2) > 12 underwent weekly dilated indirect fundoscopy and (minimum) one blood culture. Results: 77 pts were followed for 19 ± 14 d. A systemic disease (SD) that could cause RL (cotton wool spots (CW) or retinal hemorrhages (H)) was present in 19 patients; sepsis (bacteremia, fungemia, or sepsis syndrome) in 10; or both SD & sepsis in 10 (Table). Results: RL in high-AP2 ICU pts were related to SD or sepsis. In a logistic regression correlating SD, sepsis, trauma, dialysis, transfusion, central lines, and hyperalimentation with RL, only SD (Odds Ratio = 15), sepsis (OR = 6), and dialysis (OR = 5) correlated with RL. While bacteremia was associated with slightly more RL (22% → 36%, P = 0.17), as was fungemia (26% → 57%, P = 0.079), the significance of RL for any given patient was difficult to determine, especially if the patient had an SD. Simultaneous CW & H partially separated SD & sepsis from SD alone: 3/8 (38%) with SD alone had this combination vs. 7/9 (78%) with SD & sepsis (P = 0.09). Conclusion: RL are associated with sepsis, but have multiple other etiologies that limit the utility of eye exams in ICU pts. Group No sd or sepsis SD Sepsis SD & Sepsis N 38 19 10 10 Age 43 54 47 52 AP2 24 25 23 23 RL (%) 3(8) 8(42) 2(20) 9(90) CW 1 2 - H 2 3 - 2 CW & H - 3 2 7.