The impairment of small nerve fibers in severe sepsis and septic shock - 'Critical Care'

German Trial - Article

TLDR - You can detect the impairment of small nerve fibres early in the course of sepsis... we just don't know what it necessarily correlates to, or how to further correlate it to prognosis.

Results
Skin biopsies at the ankle and thigh revealed a significant decrease of intraepidermal nerve fiber density (IENFD) during the first week of sepsis and 2 weeks later. All patients developed critical illness polyneuropathy (CIP) according to electrophysiological criteria and 11 showed IENFD values lower than the 0.05 quantile. Four patients were biopsied after 4 months and still showed decreased IENFD. Results of nerve conduction studies and IENFD did considerably change over time. No differences for survival time between patients with IEFND lower and larger than 3.5 fibers/mm were found.

Conclusions
​Skin biopsy is able to detect an impairment of small sensory nerve fibers early in the course of sepsis. However, it may not be suited as a prognostic parameter for survival.