In-hospital acute stress symptoms are associated with impairment in cognition 1 year after intensive care unit admission.

RATIONALE: Prior studies have found that cognitive dysfunction is common in intensive care unit (ICU) survivors. Yet, relatively little is known about potentially modifiable risk factors for longer-term post-ICU cognitive impairment.
OBJECTIVES: To determine if in-hospital acute stress symptoms were associated with impaired 12-month cognitive functioning among ICU survivors.
METHODS: We prospectively enrolled 150 nontrauma patients without cognitive impairment or a dementia diagnosis who were admitted to an ICU for more than 24 hours. Patients were interviewed before hospital discharge and again via telephone at 12 months post-ICU.
MEASUREMENTS AND MAIN RESULTS: Demographics and clinical information were obtained through medical record reviews and in-person interviews. In-hospital acute stress symptoms were assessed with the Posttraumatic Stress Disorder Checklist-Civilian Version. Twelve-month post-ICU cognition was assessed with the modified Telephone Interview for Cognitive Status. Follow-up interviews were completed with 120 (80%) patients. Patients' mean age at hospitalization was 48.2 years (SD, 13.7). In unadjusted analyses, a greater number of in-hospital acute stress symptoms was associated with significantly greater impairment in 12-month cognitive functioning (β, -0.1; 95% confidence interval, -0.2 to -0.004; P = 0.04). After adjusting for patient and clinical factors, in-hospital acute stress symptoms were independently associated with greater impairment in 12-month cognitive functioning (β, -0.1; 95% CI, -0.2 to -0.01; P = 0.03).
CONCLUSIONS: In-hospital acute stress symptoms may be a potentially modifiable risk factor for greater impairment in cognitive functioning post-ICU. Early interventions for at-risk ICU survivors may improve longer-term outcomes.